Healthcare Provider Details

I. General information

NPI: 1679495709
Provider Name (Legal Business Name): ANNA TARGETT LLMSW
Entity Type: Individual
Gender:
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/29/2026
Last Update Date: 07/29/2026
Certification Date: 07/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2020 HOGBACK RD STE 18
ANN ARBOR MI
48105-9752
US

IV. Provider business mailing address

1557 CLARK LAKE RD
BRIGHTON MI
48114-4908
US

V. Phone/Fax

Practice location:
  • Phone: 517-481-2133
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number6851122430
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: