Provider Demographics
NPI:1720354087
Name:COSTARIDES, ANNA HEARN (NCSP)
Entity Type:Individual
Prefix:
First Name:ANNA
Middle Name:HEARN
Last Name:COSTARIDES
Suffix:
Gender:F
Credentials:NCSP
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 746450
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30374-6450
Mailing Address - Country:US
Mailing Address - Phone:251-434-3626
Mailing Address - Fax:251-445-2464
Practice Address - Street 1:1601 CENTER ST
Practice Address - Street 2:
Practice Address - City:MOBILE
Practice Address - State:AL
Practice Address - Zip Code:36604-1541
Practice Address - Country:US
Practice Address - Phone:251-410-5437
Practice Address - Fax:251-415-8578
Is Sole Proprietor?:No
Enumeration Date:2012-03-30
Last Update Date:2021-11-29
Deactivation Date:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool