Provider Demographics
NPI:1710549241
Name:ANDERSON, CARRIE RACHELLE (LPC, LMHC, SEP)
Entity type:Individual
Prefix:
First Name:CARRIE
Middle Name:RACHELLE
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:LPC, LMHC, SEP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:540 S WEST RD APT 30
Mailing Address - Street 2:
Mailing Address - City:WICKENBURG
Mailing Address - State:AZ
Mailing Address - Zip Code:85390-1177
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:540 S WEST RD APT 30
Practice Address - Street 2:
Practice Address - City:WICKENBURG
Practice Address - State:AZ
Practice Address - Zip Code:85390-1177
Practice Address - Country:US
Practice Address - Phone:317-771-9564
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-07-04
Last Update Date:2019-07-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN39002481A101YP2500X
AZLPC-15620101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional