Provider Demographics
NPI:1083733109
Name:ANDERSON, DAVID W (LMHC)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:W
Last Name:ANDERSON
Suffix:
Gender:M
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1511
Mailing Address - Street 2:
Mailing Address - City:BLAINE
Mailing Address - State:WA
Mailing Address - Zip Code:98231-1511
Mailing Address - Country:US
Mailing Address - Phone:360-676-9535
Mailing Address - Fax:360-733-4339
Practice Address - Street 1:4202 MERIDIAN ST STE 203
Practice Address - Street 2:
Practice Address - City:BELLINGHAM
Practice Address - State:WA
Practice Address - Zip Code:98226-5544
Practice Address - Country:US
Practice Address - Phone:360-676-9535
Practice Address - Fax:360-733-4339
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALH00008016101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health