Provider Demographics
NPI:1538811674
Name:ANDERSON, ALVIN DONNELL SR
Entity type:Individual
Prefix:
First Name:ALVIN
Middle Name:DONNELL
Last Name:ANDERSON
Suffix:SR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3300 COLLEGE ST APT 19
Mailing Address - Street 2:
Mailing Address - City:COLLEGE PARK
Mailing Address - State:GA
Mailing Address - Zip Code:30337-1163
Mailing Address - Country:US
Mailing Address - Phone:678-799-4369
Mailing Address - Fax:
Practice Address - Street 1:3300 COLLEGE ST APT 19
Practice Address - Street 2:
Practice Address - City:COLLEGE PARK
Practice Address - State:GA
Practice Address - Zip Code:30337-1163
Practice Address - Country:US
Practice Address - Phone:678-799-4369
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-01-20
Last Update Date:2022-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAO11725101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor