Provider Demographics
NPI:1487193694
Name:STOLL, ANITA ANNE (LCSW)
Entity type:Individual
Prefix:
First Name:ANITA
Middle Name:ANNE
Last Name:STOLL
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1221 W BEN WHITE BLVD STE 108A
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78704-7183
Mailing Address - Country:US
Mailing Address - Phone:512-789-3548
Mailing Address - Fax:
Practice Address - Street 1:1221 W BEN WHITE BLVD STE 108A
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78704-7183
Practice Address - Country:US
Practice Address - Phone:512-789-3548
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-02-21
Last Update Date:2017-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX245011041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical