Healthcare Provider Details

I. General information

NPI: 1851890511
Provider Name (Legal Business Name): VINCENT G C ANILA MA, LPC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/08/2018
Last Update Date: 05/06/2022
Certification Date: 05/06/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11111 HALL RD STE 303
UTICA MI
48317-5726
US

IV. Provider business mailing address

11111 HALL RD STE 303
UTICA MI
48317-5726
US

V. Phone/Fax

Practice location:
  • Phone: 586-997-3153
  • Fax:
Mailing address:
  • Phone: 586-997-3153
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number6401016487
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: