Provider Demographics
NPI:1306916150
Name:ANDERSON, BARBARA LEE (LICSW)
Entity type:Individual
Prefix:MRS
First Name:BARBARA
Middle Name:LEE
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:MS
Other - First Name:BARBARA
Other - Middle Name:LEE
Other - Last Name:BURTON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:905 MERCER STREET
Mailing Address - Street 2:
Mailing Address - City:PRINCETON
Mailing Address - State:WV
Mailing Address - Zip Code:24740-2909
Mailing Address - Country:US
Mailing Address - Phone:304-425-9541
Mailing Address - Fax:304-425-1332
Practice Address - Street 1:905 MERCER STREET
Practice Address - Street 2:
Practice Address - City:PRINCETON
Practice Address - State:WV
Practice Address - Zip Code:24740-2909
Practice Address - Country:US
Practice Address - Phone:304-425-9541
Practice Address - Fax:304-425-1332
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-09
Last Update Date:2010-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101Y00000X
WVDP009433541041C0700X
VA09040067181041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101Y00000XBehavioral Health & Social Service ProvidersCounselor