Provider Demographics
NPI:1386755577
Name:ANDERSON-CAPTAIN, FLORA DIANE (LPC)
Entity type:Individual
Prefix:MRS
First Name:FLORA
Middle Name:DIANE
Last Name:ANDERSON-CAPTAIN
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:MRS
Other - First Name:F.
Other - Middle Name:DIANE
Other - Last Name:ANDERSON-CAPTAIN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LPC
Mailing Address - Street 1:400 S ZANG BLVD
Mailing Address - Street 2:SUITE 828
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75208-6600
Mailing Address - Country:US
Mailing Address - Phone:214-948-9200
Mailing Address - Fax:214-948-6776
Practice Address - Street 1:400 S ZANG BLVD
Practice Address - Street 2:SUITE 828
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75208-6600
Practice Address - Country:US
Practice Address - Phone:214-948-9200
Practice Address - Fax:214-948-6776
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX13245101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN0001039475OtherMANAGED HEALTH NETWORK
TX62-42824OtherUNITED HEALTHCARE
TX125835OtherVALUE OPTION
TX3210LCOtherBLUE CROSS BLUE SHIELD
TX1091954OtherCIGNA HEALTH