Provider Demographics
NPI:1265108054
Name:ANDERSON, ALICE-ASHTON C (MS, LPC)
Entity type:Individual
Prefix:
First Name:ALICE-ASHTON
Middle Name:C
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:MS, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4621 HEATHER DR SW UNIT 209
Mailing Address - Street 2:
Mailing Address - City:ROANOKE
Mailing Address - State:VA
Mailing Address - Zip Code:24018-1993
Mailing Address - Country:US
Mailing Address - Phone:804-350-4608
Mailing Address - Fax:
Practice Address - Street 1:4621 HEATHER DR SW UNIT 209
Practice Address - Street 2:
Practice Address - City:ROANOKE
Practice Address - State:VA
Practice Address - Zip Code:24018-1993
Practice Address - Country:US
Practice Address - Phone:804-350-4608
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-20
Last Update Date:2021-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0701010569101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health