Provider Demographics
NPI:1538612528
Name:ANDERSON, HENRY (LMFT-I)
Entity type:Individual
Prefix:
First Name:HENRY
Middle Name:
Last Name:ANDERSON
Suffix:
Gender:M
Credentials:LMFT-I
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1683 UNION ST
Mailing Address - Street 2:
Mailing Address - City:SPARTANBURG
Mailing Address - State:SC
Mailing Address - Zip Code:29302-4134
Mailing Address - Country:US
Mailing Address - Phone:864-345-0193
Mailing Address - Fax:
Practice Address - Street 1:1683 UNION ST
Practice Address - Street 2:
Practice Address - City:SPARTANBURG
Practice Address - State:SC
Practice Address - Zip Code:29302-4134
Practice Address - Country:US
Practice Address - Phone:864-345-0193
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-07-26
Last Update Date:2016-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC6371106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist