Provider Demographics
NPI:1295952299
Name:ANDERSON, THEODORE SCOTT SR (LPC)
Entity type:Individual
Prefix:MR
First Name:THEODORE
Middle Name:SCOTT
Last Name:ANDERSON
Suffix:SR
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4100 ED HARRIS RD
Mailing Address - Street 2:
Mailing Address - City:OXFORD
Mailing Address - State:NC
Mailing Address - Zip Code:27565-7308
Mailing Address - Country:US
Mailing Address - Phone:919-693-3566
Mailing Address - Fax:
Practice Address - Street 1:102-A ORANGE ST. SUITE 104
Practice Address - Street 2:
Practice Address - City:OXFORD
Practice Address - State:NC
Practice Address - Zip Code:27565
Practice Address - Country:US
Practice Address - Phone:919-690-0777
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC3729101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC015A3OtherBCBS ST. HEALTH PLAN