Provider Demographics
NPI:1053947739
Name:ANDERSON, ROSS (CADC-I)
Entity type:Individual
Prefix:
First Name:ROSS
Middle Name:
Last Name:ANDERSON
Suffix:
Gender:M
Credentials:CADC-I
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:188 TIMELESS VIEW CT
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89012-5568
Mailing Address - Country:US
Mailing Address - Phone:702-544-3269
Mailing Address - Fax:
Practice Address - Street 1:4528 W CRAIG RD STE 110
Practice Address - Street 2:
Practice Address - City:NORTH LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89032-2505
Practice Address - Country:US
Practice Address - Phone:702-647-6433
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-03-13
Last Update Date:2020-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV02461-I101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)