Provider Information for 1962976613
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CONNIE L ANDERSON LPC
Sex: Female
NPI: 1962976613
Last Updated: 2019-01-16
Certification Date:
Certification Date:
Details
| Name | Value | ||||||||
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| NPI | 1962976613 | ||||||||
| Enumeration Date | 2019-01-16 | ||||||||
| NPI Type | NPI-1 Individual | ||||||||
| Sole Proprietor | NO | ||||||||
| Status | Active | ||||||||
| Mailing Address | 105 ASBURY CIR STE A HATTIESBURG, MS 39402-1397 United States Phone: 601-264-7079 | Fax:601-296-7819 | ||||||||
| Primary Practice Address | 105 ASBURY CIR STE A HATTIESBURG, MS 39402-1397 United States Phone: 601-264-7079 | Fax:601-296-7819 | ||||||||
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