Basic Information
| Provider Information | |||||||||
| NPI: | 1053604025 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | ANDERSON | ||||||||
| FirstName: | JOYCE | ||||||||
| MiddleName: | ANN | ||||||||
| NamePrefix: | MS. | ||||||||
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| Credential: | LBSW | ||||||||
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| Mailing Information | |||||||||
| Address1: | 18444 WINTHROP STREET | ||||||||
| Address2: | |||||||||
| City: | DETROIT | ||||||||
| State: | MI | ||||||||
| PostalCode: | 482352921 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3138358256 | ||||||||
| FaxNumber: | 3132707112 | ||||||||
| Practice Location | |||||||||
| Address1: | 13101 ALLEN | ||||||||
| Address2: | |||||||||
| City: | SOUTHGATE | ||||||||
| State: | MI | ||||||||
| PostalCode: | 48195 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7347857700 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 05/24/2011 | ||||||||
| LastUpdateDate: | 05/24/2011 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 104100000X | 6802059473 | MI | Y | Behavioral Health & Social Service Providers | Social Worker |
No ID Information.