Provider Demographics
NPI:1720847510
Name:ANDERSON, CARA L (LCADC)
Entity Type:Individual
Prefix:
First Name:CARA
Middle Name:L
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:LCADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:105 TRIMBLE CHAPEL SQ
Mailing Address - Street 2:
Mailing Address - City:PRESTONSBURG
Mailing Address - State:KY
Mailing Address - Zip Code:41653-8462
Mailing Address - Country:US
Mailing Address - Phone:606-874-0240
Mailing Address - Fax:606-874-8666
Practice Address - Street 1:97 TRIMBLE CHAPEL SQ
Practice Address - Street 2:
Practice Address - City:PRESTONSBURG
Practice Address - State:KY
Practice Address - Zip Code:41653-8461
Practice Address - Country:US
Practice Address - Phone:606-874-0240
Practice Address - Fax:606-874-8666
Is Sole Proprietor?:No
Enumeration Date:2024-03-15
Last Update Date:2024-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY288861101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)