Provider Demographics
NPI:1023848512
Name:ANDERSON, MEGAN JUSTINE (MS, APCC)
Entity type:Individual
Prefix:
First Name:MEGAN
Middle Name:JUSTINE
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:MS, APCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2732
Mailing Address - Street 2:
Mailing Address - City:LA MESA
Mailing Address - State:CA
Mailing Address - Zip Code:91943-2732
Mailing Address - Country:US
Mailing Address - Phone:805-624-0955
Mailing Address - Fax:
Practice Address - Street 1:2330 CENTER PL
Practice Address - Street 2:
Practice Address - City:EL CAJON
Practice Address - State:CA
Practice Address - Zip Code:92020-2809
Practice Address - Country:US
Practice Address - Phone:619-668-5820
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-08-07
Last Update Date:2024-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAPCC9842101YS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YS0200XBehavioral Health & Social Service ProvidersCounselorSchool