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General NPI Number Information
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NPI Number | 1316344971
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Entity Type | Individual
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Provider Name | ANNA SKARDOUTOS MA, LPC
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Gender | Female
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Dates
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Enumeration Date | 11/25/2014
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Last Update Date | 01/05/2024
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Provider Practice Location Address
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Address Line | 22811 GREATER MACK AVE STE. L2
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City | SAINT CLAIR SHORES
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State | MI
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Zip | 48080-2021
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Country | US
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Telephone | 586-335-2006
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Fax |
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Provider Business Mailing Address
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Address Line | 13303 KINGSTON AVE
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City | HUNTINGTON WOODS
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State | MI
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Zip | 48070-1018
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Country | US
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Telephone | 248-229-2079
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 6401012976
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License Number State | MI
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