Provider Demographics
NPI:1447833801
Name:WARREN, ANNA THERESA (LCMHC)
Entity type:Individual
Prefix:
First Name:ANNA
Middle Name:THERESA
Last Name:WARREN
Suffix:
Gender:F
Credentials:LCMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1915 HASTY RD
Mailing Address - Street 2:
Mailing Address - City:MARSHVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28103-0029
Mailing Address - Country:US
Mailing Address - Phone:704-624-4620
Mailing Address - Fax:704-624-0441
Practice Address - Street 1:1915 HASTY RD
Practice Address - Street 2:
Practice Address - City:MARSHVILLE
Practice Address - State:NC
Practice Address - Zip Code:28103-0029
Practice Address - Country:US
Practice Address - Phone:704-624-4620
Practice Address - Fax:704-624-0441
Is Sole Proprietor?:No
Enumeration Date:2021-05-04
Last Update Date:2021-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCA15228101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health