Provider Demographics
NPI:1528541232
Name:ANDERSON, CHRISTINE (MSW)
Entity Type:Individual
Prefix:MS
First Name:CHRISTINE
Middle Name:
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6 CAMBRIDGE BLVD
Mailing Address - Street 2:
Mailing Address - City:PLEASANT RIDGE
Mailing Address - State:MI
Mailing Address - Zip Code:48069-1103
Mailing Address - Country:US
Mailing Address - Phone:773-315-6635
Mailing Address - Fax:
Practice Address - Street 1:23300 GREENFIELD RD STE 122
Practice Address - Street 2:
Practice Address - City:OAK PARK
Practice Address - State:MI
Practice Address - Zip Code:48237-8408
Practice Address - Country:US
Practice Address - Phone:248-968-9508
Practice Address - Fax:248-968-9516
Is Sole Proprietor?:Yes
Enumeration Date:2018-09-09
Last Update Date:2019-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010929081041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI6801092908OtherSTATE OF MICHIGAN LICENSE