Provider Demographics
NPI:1841342979
Name:ADDIS, ANNA LOUISE (RN,LMHC,NCC)
Entity type:Individual
Prefix:
First Name:ANNA
Middle Name:LOUISE
Last Name:ADDIS
Suffix:
Gender:F
Credentials:RN,LMHC,NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:33057 PROFESSIONAL DR
Mailing Address - Street 2:
Mailing Address - City:LEESBURG
Mailing Address - State:FL
Mailing Address - Zip Code:34788-7506
Mailing Address - Country:US
Mailing Address - Phone:352-878-0081
Mailing Address - Fax:352-314-9444
Practice Address - Street 1:33057 PROFESSIONAL DR
Practice Address - Street 2:
Practice Address - City:LEESBURG
Practice Address - State:FL
Practice Address - Zip Code:34788-7506
Practice Address - Country:US
Practice Address - Phone:352-878-0081
Practice Address - Fax:352-314-9444
Is Sole Proprietor?:No
Enumeration Date:2007-01-17
Last Update Date:2007-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH6043101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health