Provider Demographics
NPI:1699539122
Name:ANDERSON, ROGER LEE III (RBT)
Entity type:Individual
Prefix:MR
First Name:ROGER
Middle Name:LEE
Last Name:ANDERSON
Suffix:III
Gender:M
Credentials:RBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:13003 E COAL HOPPER LN APT 1B
Mailing Address - Street 2:
Mailing Address - City:MIDLOTHIAN
Mailing Address - State:VA
Mailing Address - Zip Code:23113-4607
Mailing Address - Country:US
Mailing Address - Phone:540-845-6348
Mailing Address - Fax:
Practice Address - Street 1:1550 OAKBRIDGE DR
Practice Address - Street 2:
Practice Address - City:POWHATAN
Practice Address - State:VA
Practice Address - Zip Code:23139-8063
Practice Address - Country:US
Practice Address - Phone:804-557-0881
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-02-06
Last Update Date:2024-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician