Provider Demographics
NPI:1295280634
Name:ANDERSON, ADRIENNE
Entity type:Individual
Prefix:
First Name:ADRIENNE
Middle Name:
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 1:550 FESLER ST
Mailing Address - Street 2:SUITE G-1
Mailing Address - City:EL CAJON
Mailing Address - State:CA
Mailing Address - Zip Code:92020-1901
Mailing Address - Country:US
Mailing Address - Phone:619-588-5361
Mailing Address - Fax:619-588-5421
Practice Address - Street 1:550 FESLER ST
Practice Address - Street 2:SUITE G-1
Practice Address - City:EL CAJON
Practice Address - State:CA
Practice Address - Zip Code:92020-1901
Practice Address - Country:US
Practice Address - Phone:619-588-5361
Practice Address - Fax:619-588-5421
Is Sole Proprietor?:Yes
Enumeration Date:2016-08-15
Last Update Date:2016-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)