Healthcare Provider Details

I. General information

NPI: 1356564009
Provider Name (Legal Business Name): BRANDI ANITRA WEEMS LLMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/11/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13101 ALLEN RD
SOUTHGATE MI
48195-2216
US

IV. Provider business mailing address

13101 ALLEN RD
SOUTHGATE MI
48195-2216
US

V. Phone/Fax

Practice location:
  • Phone: 734-785-7718
  • Fax: 734-287-8221
Mailing address:
  • Phone: 734-785-7718
  • Fax: 734-287-8221

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number6802083713
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: