Provider Demographics
NPI:1407049588
Name:FARRAR, ANITA MARTHA (EDS)
Entity Type:Individual
Prefix:MRS
First Name:ANITA
Middle Name:MARTHA
Last Name:FARRAR
Suffix:
Gender:F
Credentials:EDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:32437 FIVE MILE RD
Mailing Address - Street 2:
Mailing Address - City:LIVONIA
Mailing Address - State:MI
Mailing Address - Zip Code:48154-3039
Mailing Address - Country:US
Mailing Address - Phone:248-210-4556
Mailing Address - Fax:734-421-0306
Practice Address - Street 1:32437 FIVE MILE RD
Practice Address - Street 2:
Practice Address - City:LIVONIA
Practice Address - State:MI
Practice Address - Zip Code:48154-3039
Practice Address - Country:US
Practice Address - Phone:248-210-4556
Practice Address - Fax:734-421-0306
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-22
Last Update Date:2007-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6401003789101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor