Basic Information
| Provider Information | |||||||||
| NPI: | 1316344971 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SKARDOUTOS | ||||||||
| FirstName: | ANNA | ||||||||
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| Credential: | MA, LPC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 13303 KINGSTON AVE | ||||||||
| Address2: | |||||||||
| City: | HUNTINGTON WOODS | ||||||||
| State: | MI | ||||||||
| PostalCode: | 480701018 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2482292079 | ||||||||
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| Practice Location | |||||||||
| Address1: | 22811 GREATER MACK AVE | ||||||||
| Address2: | STE. L2 | ||||||||
| City: | SAINT CLAIR SHORES | ||||||||
| State: | MI | ||||||||
| PostalCode: | 480802021 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5863352006 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 11/25/2014 | ||||||||
| LastUpdateDate: | 12/30/2016 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YP2500X | 6401012976 | MI | Y | Behavioral Health & Social Service Providers | Counselor | Professional |
No ID Information.