Healthcare Provider Details

I. General information

NPI: 1538204888
Provider Name (Legal Business Name): ANNE RUTH MARKIEWICZ MSW,LICSW,CDP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/21/2007
Last Update Date: 05/21/2024
Certification Date: 05/21/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2424 W WASHINGTON AVE STE 200
JACKSON MI
49203-1236
US

IV. Provider business mailing address

2424 W WASHINGTON AVE STE 200
JACKSON MI
49203-1236
US

V. Phone/Fax

Practice location:
  • Phone: 517-205-4001
  • Fax:
Mailing address:
  • Phone: 517-205-4001
  • Fax: 517-205-0126

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number6801069979
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberCP00004940
License Number StateWA
# 3
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLW00008039
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: