Provider Demographics
NPI:1194200576
Name:ANASTASIA, ROWAN GUINEVERE ANN (LLMSW)
Entity Type:Individual
Prefix:MRS
First Name:ROWAN
Middle Name:GUINEVERE ANN
Last Name:ANASTASIA
Suffix:
Gender:F
Credentials:LLMSW
Other - Prefix:MR
Other - First Name:NICHOLAS
Other - Middle Name:A
Other - Last Name:ANASTASIA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LLMSW
Mailing Address - Street 1:6500 N INKSTER RD
Mailing Address - Street 2:
Mailing Address - City:DEARBORN HEIGHTS
Mailing Address - State:MI
Mailing Address - Zip Code:48127-1807
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:6500 N INKSTER RD
Practice Address - Street 2:
Practice Address - City:DEARBORN HEIGHTS
Practice Address - State:MI
Practice Address - Zip Code:48127-1807
Practice Address - Country:US
Practice Address - Phone:765-073-4627
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-10-01
Last Update Date:2024-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
104100000X
MI68511029201041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker