Provider Demographics
NPI:1184973497
Name:ANDERSON, MICHELLE LORAINE
Entity type:Individual
Prefix:
First Name:MICHELLE
Middle Name:LORAINE
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5636 FAUST AVE
Mailing Address - Street 2:
Mailing Address - City:WOODLAND HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91367-4329
Mailing Address - Country:US
Mailing Address - Phone:562-301-5256
Mailing Address - Fax:
Practice Address - Street 1:5636 FAUST AVE
Practice Address - Street 2:
Practice Address - City:WOODLAND HILLS
Practice Address - State:CA
Practice Address - Zip Code:91367-4329
Practice Address - Country:US
Practice Address - Phone:562-301-5256
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-08-31
Last Update Date:2024-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor