Healthcare Provider Details

I. General information

NPI: 1407159684
Provider Name (Legal Business Name): MS. AQUANETTER TONI LITTLETON
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/10/2010
Last Update Date: 12/10/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

22900 REMICK DR
CLINTON TWP MI
48036-2797
US

IV. Provider business mailing address

3259 TUXEDO ST
DETROIT MI
48206-1027
US

V. Phone/Fax

Practice location:
  • Phone: 586-783-4802
  • Fax: 586-783-4805
Mailing address:
  • Phone: 313-733-8288
  • Fax: 313-733-8288

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: