Provider Demographics
NPI:1528295714
Name:ANDERSON, DANICA (MA, CCCJS #16713)
Entity type:Individual
Prefix:MS
First Name:DANICA
Middle Name:
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:MA, CCCJS #16713
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7638 58TH AVE NE
Mailing Address - Street 2:
Mailing Address - City:OLYMPIA
Mailing Address - State:WA
Mailing Address - Zip Code:98516-9307
Mailing Address - Country:US
Mailing Address - Phone:360-455-4701
Mailing Address - Fax:
Practice Address - Street 1:7638 58TH AVENUE NE
Practice Address - Street 2:NORTHSTAR LIFE SERVICES
Practice Address - City:OLYMPIA
Practice Address - State:WA
Practice Address - Zip Code:98516-9307
Practice Address - Country:US
Practice Address - Phone:360-455-4701
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-16
Last Update Date:2009-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WARC00027143101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA$$$$$$$$$OtherSSN