Healthcare Provider Details

I. General information

NPI: 1720804222
Provider Name (Legal Business Name): AMBER ANDERSON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/29/2024
Last Update Date: 05/26/2026
Certification Date: 05/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25899 W 12 MILE RD STE 320
SOUTHFIELD MI
48034-8325
US

IV. Provider business mailing address

27330 ARBORWAY RD UNIT 32
SOUTHFIELD MI
48033-3584
US

V. Phone/Fax

Practice location:
  • Phone: 248-264-3522
  • Fax:
Mailing address:
  • Phone: 313-766-1697
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: