Mark Shane Anderson, RAC, CCDP, CCGC

Primary specialty

Addiction (Substance Use Disorder) CounselorTaxonomy code 101YA0400X

License

2251 CIT Issued in LA

Practice address

4105 Kirkman St
Lake Charles, LA 70607-4603

Phone

(337) 475-8738

Fax

(337) 475-8054

NPI assigned

May 30, 2007

Last updated

Sep 23, 2011By the provider in NPPES

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1180483200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1316736000000",
    "number": "1184825705",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "811 FALL ST",
            "city": "LAKE CHARLES",
            "state": "LA",
            "postal_code": "706018659",
            "telephone_number": "337-433-4475"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4105 KIRKMAN ST",
            "city": "LAKE CHARLES",
            "state": "LA",
            "postal_code": "706074603",
            "telephone_number": "337-475-8738",
            "fax_number": "337-475-8054"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ANDERSON",
        "first_name": "MARK",
        "middle_name": "SHANE",
        "name_prefix": "Mr.",
        "credential": "RAC, CCDP, CCGC",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-05-30",
        "last_updated": "2011-09-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "LA",
            "license": "2251 CIT",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Andre Anderson II, BS
• Cheryl Anderson, LMT
• James M. Anderson, M.D.
• Kathryn Claire Anderson
• Kim B Anderson, PT
• Robert Michael Anderson, M.D.
• Terrance Anderson
• Andersons Transportation LLC
• Derek Andrepont
• Katrina Andrus

• Addiction (Substance Use Disorder) Counselor in Lake Charles, LA
• Providers in Lake Charles, LA by specialty
• Addiction (Substance Use Disorder) Counselor in Louisiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 23, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.