Healthcare Provider Details

I. General information

NPI: 1780976423
Provider Name (Legal Business Name): BRIAN HOWARD ACKERSON MSW
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/13/2011
Last Update Date: 05/13/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8303 PLATT RD
SALINE MI
48176-9773
US

IV. Provider business mailing address

PO BOX 2060
ANN ARBOR MI
48106-2060
US

V. Phone/Fax

Practice location:
  • Phone: 734-295-4249
  • Fax:
Mailing address:
  • Phone: 734-429-2531
  • Fax: 734-429-4561

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number6801019013
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: