Individual provider · NPI-1
Matthew Anderson
Counselor, Addiction (Substance Use Disorder) · Portsmouth, OH
NPI number1699412429
StatusActive
Last updated in NPPESJan 9, 2024
Details
- NPI
- 1699412429
- Entity type
- Individual (NPI-1)
- Name
- Matthew Anderson
- Sex
- Male
- Sole proprietor
- Yes
- Enumeration date
- May 13, 2022
- Certification date
- Jan 9, 2024
- Last updated
- Jan 9, 2024
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 101YA0400X | Counselor, Addiction (Substance Use Disorder) | CDCA.186162 | OH | Yes |
| 101YM0800X | Counselor, Mental Health | QMHS | OH | |
| 171M00000X | Case Manager/Care Coordinator | 2022 | OH |
Practice location
411 Court StPortsmouth, OH 45662-3932
Phone 740-354-6685
Mailing address
411 Court StPortsmouth, OH 45662-3932
Phone 740-354-6685
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