Provider Demographics
NPI:1689709107
Name:MCCAIN, ANNETTE (PHD,LPC,LLP,DOT-SAP)
Entity Type:Individual
Prefix:DR
First Name:ANNETTE
Middle Name:
Last Name:MCCAIN
Suffix:
Gender:F
Credentials:PHD,LPC,LLP,DOT-SAP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 441381
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48244-1381
Mailing Address - Country:US
Mailing Address - Phone:313-952-1963
Mailing Address - Fax:313-567-1740
Practice Address - Street 1:7633 E JEFFERSON AVE
Practice Address - Street 2:SUITE 110
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48214-3730
Practice Address - Country:US
Practice Address - Phone:313-952-1963
Practice Address - Fax:313-567-1740
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-23
Last Update Date:2013-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6401002550101YP2500X
MI6301008988103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional