Provider Demographics
NPI:1750691481
Name:ANDERSON, ANNIE BERNADETTE (DR)
Entity type:Individual
Prefix:
First Name:ANNIE
Middle Name:BERNADETTE
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:DR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6121B HERON AVE
Mailing Address - Street 2:
Mailing Address - City:EWA BEACH
Mailing Address - State:HI
Mailing Address - Zip Code:96706-3341
Mailing Address - Country:US
Mailing Address - Phone:808-489-2486
Mailing Address - Fax:
Practice Address - Street 1:95-782 WIKAO STREET
Practice Address - Street 2:N-201
Practice Address - City:MILILANI
Practice Address - State:HI
Practice Address - Zip Code:96789-5089
Practice Address - Country:US
Practice Address - Phone:714-702-9577
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-10-15
Last Update Date:2024-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No3245S0500XResidential Treatment FacilitiesSubstance Abuse Rehabilitation FacilitySubstance Abuse Treatment, Children