Provider Demographics
NPI:1386762383
Name:ANDERSON, CAROL J (LPC)
Entity type:Individual
Prefix:
First Name:CAROL
Middle Name:J
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:336 NE NORTON AVE
Mailing Address - Street 2:SUITE #5
Mailing Address - City:BEND
Mailing Address - State:OR
Mailing Address - Zip Code:97701-4350
Mailing Address - Country:US
Mailing Address - Phone:541-390-9719
Mailing Address - Fax:541-317-8488
Practice Address - Street 1:336 NE NORTON AVE
Practice Address - Street 2:SUITE #5
Practice Address - City:BEND
Practice Address - State:OR
Practice Address - Zip Code:97701-4350
Practice Address - Country:US
Practice Address - Phone:541-390-9719
Practice Address - Fax:541-317-8488
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORC1546101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional