Healthcare Provider Details

I. General information

NPI: 1730587205
Provider Name (Legal Business Name): FELICIA ANDERSON MA, LLPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/15/2014
Last Update Date: 05/23/2024
Certification Date: 05/23/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6309 MACK AVE
DETROIT MI
48207-2302
US

IV. Provider business mailing address

6309 MACK AVE
DETROIT MI
48207-2302
US

V. Phone/Fax

Practice location:
  • Phone: 313-331-3435
  • Fax: 313-924-8145
Mailing address:
  • Phone: 313-331-3435
  • Fax: 313-924-8145

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code324500000X
TaxonomySubstance Abuse Rehabilitation Facility
License Number820103
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number64510223071
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: