Provider Demographics
NPI:1528392867
Name:ANDERSON HOUSE LLC
Entity Type:Organization
Organization Name:ANDERSON HOUSE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:EDWARD
Authorized Official - Middle Name:MANUEL
Authorized Official - Last Name:ANDERSON
Authorized Official - Suffix:JR
Authorized Official - Credentials:CAC CPC
Authorized Official - Phone:313-205-0411
Mailing Address - Street 1:28366 FRANKLIN RIVER DR APT 106
Mailing Address - Street 2:
Mailing Address - City:SOUTHFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48034-5409
Mailing Address - Country:US
Mailing Address - Phone:313-205-0411
Mailing Address - Fax:248-996-8478
Practice Address - Street 1:28366 FRANKLIN RIVER DR APT 106
Practice Address - Street 2:
Practice Address - City:SOUTHFIELD
Practice Address - State:MI
Practice Address - Zip Code:48034-5409
Practice Address - Country:US
Practice Address - Phone:313-205-0411
Practice Address - Fax:248-996-8478
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-09-18
Last Update Date:2009-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI822780101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Single Specialty