Provider Demographics
NPI:1447975651
Name:ANDERSON, ASHAWNTE (LAC-T)
Entity type:Individual
Prefix:
First Name:ASHAWNTE
Middle Name:
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:LAC-T
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18909 REDBUD LN
Mailing Address - Street 2:
Mailing Address - City:SPRING HILL
Mailing Address - State:KS
Mailing Address - Zip Code:66083-4576
Mailing Address - Country:US
Mailing Address - Phone:913-201-6013
Mailing Address - Fax:
Practice Address - Street 1:11633 W 83RD TER
Practice Address - Street 2:
Practice Address - City:LENEXA
Practice Address - State:KS
Practice Address - Zip Code:66214-1538
Practice Address - Country:US
Practice Address - Phone:913-592-9710
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-10-10
Last Update Date:2022-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)