Provider Demographics
NPI:1467210278
Name:ANDERSON, ADRIAN KRISTINE MARIE
Entity Type:Individual
Prefix:
First Name:ADRIAN
Middle Name:KRISTINE MARIE
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4893 E BELTLINE AVE NE
Mailing Address - Street 2:STE 310
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49525
Mailing Address - Country:US
Mailing Address - Phone:616-279-6414
Mailing Address - Fax:616-591-3393
Practice Address - Street 1:4893 E BELTLINE AVE NE
Practice Address - Street 2:STE 310
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49525
Practice Address - Country:US
Practice Address - Phone:616-279-6414
Practice Address - Fax:616-591-3393
Is Sole Proprietor?:No
Enumeration Date:2024-03-07
Last Update Date:2024-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician