Provider Demographics
NPI:1831175579
Name:ANDERSON, GEORG-ETTA (LCSW)
Entity type:Individual
Prefix:
First Name:GEORG-ETTA
Middle Name:
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:GEORGI
Other - Middle Name:
Other - Last Name:ANDERSON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LCSW
Mailing Address - Street 1:450 GIBNER RD
Mailing Address - Street 2:DUNHAM U.S. ARMY HEALTH CLINIC
Mailing Address - City:CARLISLE BARRACKS
Mailing Address - State:PA
Mailing Address - Zip Code:17013-5003
Mailing Address - Country:US
Mailing Address - Phone:717-245-3041
Mailing Address - Fax:717-245-3815
Practice Address - Street 1:450 GIBNER RD
Practice Address - Street 2:DUNHAM U.S. ARMY HEALTH CLINIC
Practice Address - City:CARLISLE BARRACKS
Practice Address - State:PA
Practice Address - Zip Code:17013-5003
Practice Address - Country:US
Practice Address - Phone:717-245-3041
Practice Address - Fax:717-245-3815
Is Sole Proprietor?:No
Enumeration Date:2005-12-15
Last Update Date:2009-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PACW008102L1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical