Provider Demographics
NPI:1275165904
Name:FEALA, ANNA MARIA
Entity Type:Individual
Prefix:
First Name:ANNA
Middle Name:MARIA
Last Name:FEALA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:ANNA
Other - Middle Name:MARIE
Other - Last Name:BEARDEN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PROGRESSIVE ADVOCACY
Mailing Address - Street 1:PO BOX 146
Mailing Address - Street 2:
Mailing Address - City:BEULAH
Mailing Address - State:MI
Mailing Address - Zip Code:49617-0146
Mailing Address - Country:US
Mailing Address - Phone:231-590-2662
Mailing Address - Fax:
Practice Address - Street 1:9280 WORDEN RD
Practice Address - Street 2:
Practice Address - City:BEULAH
Practice Address - State:MI
Practice Address - Zip Code:49617-9731
Practice Address - Country:US
Practice Address - Phone:231-590-2662
Practice Address - Fax:231-383-4288
Is Sole Proprietor?:Yes
Enumeration Date:2020-02-11
Last Update Date:2020-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor