Provider Demographics
NPI:1902129174
Name:ANDERSON, STEWART LEE (LPC)
Entity Type:Individual
Prefix:
First Name:STEWART
Middle Name:LEE
Last Name:ANDERSON
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:60 BUSH RIVER DRIVE
Mailing Address - Street 2:
Mailing Address - City:FARMVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:23901-0248
Mailing Address - Country:US
Mailing Address - Phone:434-696-1623
Mailing Address - Fax:434-392-9221
Practice Address - Street 1:11387 COURTHOUSE ROAD
Practice Address - Street 2:
Practice Address - City:LUNENBURG
Practice Address - State:VA
Practice Address - Zip Code:23952-0040
Practice Address - Country:US
Practice Address - Phone:434-696-1623
Practice Address - Fax:434-696-1753
Is Sole Proprietor?:No
Enumeration Date:2010-03-02
Last Update Date:2010-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0701004784101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1528091063Medicaid