Provider Demographics
NPI:1306270947
Name:ANDERSON, LA DONNA GRACE (MS REHAB COUNSELING)
Entity type:Individual
Prefix:MS
First Name:LA DONNA
Middle Name:GRACE
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:MS REHAB COUNSELING
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:737 NE 37TH ST
Mailing Address - Street 2:NA
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73105-7209
Mailing Address - Country:US
Mailing Address - Phone:405-314-5499
Mailing Address - Fax:
Practice Address - Street 1:737 NE 37TH ST
Practice Address - Street 2:NA
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73105-7209
Practice Address - Country:US
Practice Address - Phone:405-314-5499
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-31
Last Update Date:2013-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health