Healthcare Provider Details

I. General information

NPI: 1740356740
Provider Name (Legal Business Name): ANNE C MCINNIS LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/28/2006
Last Update Date: 02/20/2025
Certification Date: 02/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7300 DIXIE HWY STE 1000
CLARKSTON MI
48346-5105
US

IV. Provider business mailing address

7300 DIXIE HWY STE 1000
CLARKSTON MI
48346-5105
US

V. Phone/Fax

Practice location:
  • Phone: 517-882-3732
  • Fax: 517-882-3633
Mailing address:
  • Phone: 517-882-3732
  • Fax: 517-882-3633

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number7222123
License Number StateWI
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number6801117439
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: