Healthcare Provider Details

I. General information

NPI: 1548322548
Provider Name (Legal Business Name): BART ANTHONY PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/15/2006
Last Update Date: 07/10/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

43996 WOODWARD AVE STE 101
BLOOMFIELD HILLS MI
48302-5027
US

IV. Provider business mailing address

43996 WOODWARD AVE STE 101
BLOOMFIELD HILLS MI
48302-5027
US

V. Phone/Fax

Practice location:
  • Phone: 248-338-2988
  • Fax: 248-338-1322
Mailing address:
  • Phone: 248-338-2988
  • Fax: 248-338-1322

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number631300
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number631300
License Number StateMI

VIII. Authorized Official

Name: MR. BART ANTHONY
Title or Position: PRESIDENT OWNER
Credential: MA LLP
Phone: 248-338-2988