Provider Demographics
NPI:1730805508
Name:ANDERSON, GARY THOMAS (LPC)
Entity type:Individual
Prefix:
First Name:GARY
Middle Name:THOMAS
Last Name:ANDERSON
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:953 INDIAN CREEK RD
Mailing Address - Street 2:
Mailing Address - City:AMHERST
Mailing Address - State:VA
Mailing Address - Zip Code:24521-5002
Mailing Address - Country:US
Mailing Address - Phone:434-221-2168
Mailing Address - Fax:
Practice Address - Street 1:1014 E MARKET ST
Practice Address - Street 2:
Practice Address - City:CHARLOTTESVILLE
Practice Address - State:VA
Practice Address - Zip Code:22902-5345
Practice Address - Country:US
Practice Address - Phone:434-972-1745
Practice Address - Fax:434-979-5119
Is Sole Proprietor?:No
Enumeration Date:2022-10-13
Last Update Date:2022-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0701011605101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA0701011605OtherLPC LICENSE NUMBER