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General NPI Number Information
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NPI Number | 1942716634
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Entity Type | Individual
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Provider Name | PAULA DENISE ANDERSON DOCTOR OF MINISTRY
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Gender | Female
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Dates
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Enumeration Date | 12/18/2017
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Last Update Date | 12/18/2017
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Provider Practice Location Address
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Address Line | 18629 W MCNICHOLS RD
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City | DETROIT
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State | MI
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Zip | 48219-4131
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Country | US
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Telephone | 313-541-1350
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Fax |
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Provider Business Mailing Address
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Address Line | 24300 CIVIC CENTER DR
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City | SOUTHFIELD
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State | MI
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Zip | 48033-2563
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Country | US
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Telephone | 734-991-6237
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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 | 103K00000X
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Taxonomy Name | Behavior Analyst
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License Number | 6401006801
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License Number State | MI
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