Provider Demographics
NPI:1356406284
Name:ANDERSON MEDIATION SERVICES, INC
Entity type:Organization
Organization Name:ANDERSON MEDIATION SERVICES, INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:ANDERSON
Authorized Official - Suffix:
Authorized Official - Credentials:MA
Authorized Official - Phone:434-239-2004
Mailing Address - Street 1:434 GRAVES MILL RD BLDG 100
Mailing Address - Street 2:
Mailing Address - City:LYNCHBURG
Mailing Address - State:VA
Mailing Address - Zip Code:24502-4208
Mailing Address - Country:US
Mailing Address - Phone:434-239-2004
Mailing Address - Fax:434-239-2005
Practice Address - Street 1:434 GRAVES MILL RD BLDG 100
Practice Address - Street 2:
Practice Address - City:LYNCHBURG
Practice Address - State:VA
Practice Address - Zip Code:24502-4208
Practice Address - Country:US
Practice Address - Phone:434-239-2004
Practice Address - Fax:434-239-2005
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-22
Last Update Date:2011-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Single Specialty