Provider Demographics
NPI:1780032516
Name:ANTHONY, ANJANETTE MARIE
Entity Type:Individual
Prefix:MRS
First Name:ANJANETTE
Middle Name:MARIE
Last Name:ANTHONY
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 1:5101 OBANNON DR APT 238
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89146-3460
Mailing Address - Country:US
Mailing Address - Phone:510-837-9194
Mailing Address - Fax:
Practice Address - Street 1:5101 OBANNON DR APT 238
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89146-3460
Practice Address - Country:US
Practice Address - Phone:510-837-9194
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-06-02
Last Update Date:2016-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor