Provider Demographics
NPI:1194029991
Name:ANASTASOFF, ADAM LEE (MA, LPC)
Entity Type:Individual
Prefix:MR
First Name:ADAM
Middle Name:LEE
Last Name:ANASTASOFF
Suffix:
Gender:M
Credentials:MA, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13316 IDA CENTER RD
Mailing Address - Street 2:
Mailing Address - City:IDA
Mailing Address - State:MI
Mailing Address - Zip Code:48140-9722
Mailing Address - Country:US
Mailing Address - Phone:734-347-4950
Mailing Address - Fax:
Practice Address - Street 1:13316 IDA CENTER RD
Practice Address - Street 2:
Practice Address - City:IDA
Practice Address - State:MI
Practice Address - Zip Code:48140-9722
Practice Address - Country:US
Practice Address - Phone:734-347-4950
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-01-07
Last Update Date:2015-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6401011875101Y00000X, 101YM0800X, 101YP2500X, 106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist