Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 101Y00000X | Counselor | WA861035 | LA |
Y | 101YA0400X | Addiction Counselor (Substance Use Disorder) | WA861035 | LA |
N | 101YM0800X | Mental Health Counselor | WA861035 | LA |
N | 101YP1600X | Pastoral Counselor | WA861035 | LA |
NPI | 1376115287 |
---|---|
Provider Name | Dr. Willie Anderson JR. |
First Address | Denham Springs, LA 70726-4102 |
Second Address | Denham Springs, LA 70726-4102 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 12/07/2021 |
Last Update Date | 12/07/2021 |