Provider Demographics
NPI:1770954547
Name:ANDERSON, MARKITA B (MA, MS, NCC, LPC)
Entity type:Individual
Prefix:
First Name:MARKITA
Middle Name:B
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:MA, MS, NCC, LPC
Other - Prefix:MRS
Other - First Name:MARKITA
Other - Middle Name:B
Other - Last Name:MARTIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA, MS, NCC, LPC
Mailing Address - Street 1:58725 BELLEVIEW RD STE A2
Mailing Address - Street 2:
Mailing Address - City:PLAQUEMINE
Mailing Address - State:LA
Mailing Address - Zip Code:70764-3948
Mailing Address - Country:US
Mailing Address - Phone:225-286-9333
Mailing Address - Fax:866-601-5333
Practice Address - Street 1:59595 BELLEVIEW RD
Practice Address - Street 2:
Practice Address - City:PLAQUEMINE
Practice Address - State:LA
Practice Address - Zip Code:70764-6500
Practice Address - Country:US
Practice Address - Phone:866-530-6111
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-10-19
Last Update Date:2023-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X, 171M00000X
LA6972101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No171M00000XOther Service ProvidersCase Manager/Care Coordinator
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA600720433Medicaid
LA600751961Medicaid