Provider Demographics
NPI:1699826941
Name:ANDERSON, ANGELA ANNETTE (PHD, LPC, NCC, ACS)
Entity type:Individual
Prefix:
First Name:ANGELA
Middle Name:ANNETTE
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:PHD, LPC, NCC, ACS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3320 MILL CREEK RD
Mailing Address - Street 2:
Mailing Address - City:MILLBORO
Mailing Address - State:VA
Mailing Address - Zip Code:24460-2668
Mailing Address - Country:US
Mailing Address - Phone:540-589-8243
Mailing Address - Fax:
Practice Address - Street 1:3320 MILL CREEK RD
Practice Address - Street 2:
Practice Address - City:MILLBORO
Practice Address - State:VA
Practice Address - Zip Code:24460-2668
Practice Address - Country:US
Practice Address - Phone:540-589-8243
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-15
Last Update Date:2025-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0701004151101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDH2480023OtherCAREFIRST BCBS
MD314791OtherMHN
VA1699826941Medicaid