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MR. JUSTIN SHAW ANDERSON LCSW
Clinical >> Social Worker >> Behavioral Health & Social Service ProvidersRegistrant NPI Number: 1255567780
Individual Registrant:MR. JUSTIN SHAW ANDERSON LCSW
Gender: M
Sole Proprietor
Gender: M
Sole Proprietor
Location and contact information for practice:
1810 PLUM ST STE F VALDOSTA, GA 31601-7583 US
Tel: 229-241-8995 Fax: 229-241-8997
Tel: 229-241-8995 Fax: 229-241-8997
Contact information for business:
1810 PLUM ST STE F VALDOSTA, GA 31601-7583 US
Tel: 229-241-8995 Fax: 229-241-8997
Tel: 229-241-8995 Fax: 229-241-8997
Registration Information:
NPI: 1255567780
Entity Type: Individual
Entity Type: Individual
Specialty information:
| Primary | Code | Category/Description | State | License Number |
|---|---|---|---|---|
| Y | 1041C0700X | Behavioral Health & Social Service Providers Social Worker Clinical | GA | CSW003946 |
Legacy codes, insurance codes and state license numbers:
| Issuer | Number | State | Type |
|---|---|---|---|
| 3012275978A | GA | 05 |
