Provider Demographics
NPI:1982732426
Name:ANDERSON, DEIDREA MARCELLA (LCSW, LAC)
Entity type:Individual
Prefix:MS
First Name:DEIDREA
Middle Name:MARCELLA
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:LCSW, LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7010 SIMMS ST # 15-202
Mailing Address - Street 2:
Mailing Address - City:ARVADA
Mailing Address - State:CO
Mailing Address - Zip Code:80004-1394
Mailing Address - Country:US
Mailing Address - Phone:805-444-0046
Mailing Address - Fax:
Practice Address - Street 1:7010 SIMMS ST # 15-202
Practice Address - Street 2:
Practice Address - City:ARVADA
Practice Address - State:CO
Practice Address - Zip Code:80004-1394
Practice Address - Country:US
Practice Address - Phone:805-444-0046
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-28
Last Update Date:2021-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO6747101YA0400X
CO19891041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)