Provider Demographics
NPI:1356577308
Name:ANDERSON, RULONDO TEHRAN SR (MA, LPC)
Entity type:Individual
Prefix:MR
First Name:RULONDO
Middle Name:TEHRAN
Last Name:ANDERSON
Suffix:SR
Gender:M
Credentials:MA, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2013 BEECHMONT ST
Mailing Address - Street 2:
Mailing Address - City:HARRISBURG
Mailing Address - State:NC
Mailing Address - Zip Code:28075-8365
Mailing Address - Country:US
Mailing Address - Phone:704-252-4381
Mailing Address - Fax:866-309-6385
Practice Address - Street 1:1923 J N PEASE PL STE 104
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28262-4534
Practice Address - Country:US
Practice Address - Phone:704-252-4381
Practice Address - Fax:866-309-6385
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-04
Last Update Date:2021-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC9371101YP2500X
NCS9371101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty