Provider Demographics
NPI:1235796566
Name:ANDERSON, AFRICA C (EDS ATP, RN)
Entity type:Individual
Prefix:MS
First Name:AFRICA
Middle Name:C
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:EDS ATP, RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20 DANADA SQ W # 283
Mailing Address - Street 2:
Mailing Address - City:WHEATON
Mailing Address - State:IL
Mailing Address - Zip Code:60189-2000
Mailing Address - Country:US
Mailing Address - Phone:630-915-5998
Mailing Address - Fax:
Practice Address - Street 1:20 DANADA SQ W # 283
Practice Address - Street 2:
Practice Address - City:WHEATON
Practice Address - State:IL
Practice Address - Zip Code:60189-2000
Practice Address - Country:US
Practice Address - Phone:312-857-5262
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-05-22
Last Update Date:2024-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL041557661163WC0400X, 163WA0400X, 163WP0808X, 163WS0200X, 163W00000X
101Y00000X, 101YM0800X, 106E00000X, 251B00000X, 171M00000X, 225C00000X, 225CA2400X, 251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163W00000XNursing Service ProvidersRegistered Nurse
No163WC0400XNursing Service ProvidersRegistered NurseCase ManagementGroup - Multi-Specialty
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No106E00000XBehavioral Health & Social Service ProvidersAssistant Behavior Analyst
No163WA0400XNursing Service ProvidersRegistered NurseAddiction (Substance Use Disorder)
No163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health
No251B00000XAgenciesCase Management
No163WS0200XNursing Service ProvidersRegistered NurseSchool
No171M00000XOther Service ProvidersCase Manager/Care Coordinator
No225C00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Counselor
No225CA2400XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation CounselorAssistive Technology Practitioner
No251S00000XAgenciesCommunity/Behavioral Health