Healthcare Provider Details

I. General information

NPI: 1316232242
Provider Name (Legal Business Name): EDWARD A ANIAPAM BS., CADC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/20/2011
Last Update Date: 06/20/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2755 COLLINGWOOD ST
DETROIT MI
48206-1476
US

IV. Provider business mailing address

62 PINEVIEW DR.
TROY MI
48085
US

V. Phone/Fax

Practice location:
  • Phone: 313-305-7040
  • Fax: 313-894-7460
Mailing address:
  • Phone: 313-399-2563
  • Fax: 313-894-7460

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number1-04689
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: