Provider Demographics
NPI:1295716009
Name:HARRISON, ANITA DIANNE (LCSW)
Entity type:Individual
Prefix:MRS
First Name:ANITA
Middle Name:DIANNE
Last Name:HARRISON
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 35395
Mailing Address - Street 2:RESOURCE GUIDANCE SERVICES INC
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23235-0395
Mailing Address - Country:US
Mailing Address - Phone:804-378-3364
Mailing Address - Fax:804-378-2078
Practice Address - Street 1:4914 RADFORD AVE
Practice Address - Street 2:STE 207
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23230-3538
Practice Address - Country:US
Practice Address - Phone:804-688-0225
Practice Address - Fax:804-355-0225
Is Sole Proprietor?:No
Enumeration Date:2005-11-09
Last Update Date:2008-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0904002774104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA187231OtherMHN
VA179174OtherBCBS
VAO86869OtherOPTIMA
VA105618OtherBCBS
VA008924554Medicaid
VA008928169Medicaid
VA179130OtherBCBS
VA229350OtherVALUEOPTIONS
VA187231OtherTRICARE
VA008928169Medicaid
800002964Medicare ID - Type Unspecified