Provider Demographics
NPI:1871653188
Name:RUPP, ANNE G (LMSW)
Entity Type:Individual
Prefix:MRS
First Name:ANNE
Middle Name:G
Last Name:RUPP
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:ANNE
Other - Middle Name:G
Other - Last Name:STEPHENS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:5629 PRIORY LANE
Mailing Address - Street 2:
Mailing Address - City:BLOOMFIELD HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48301
Mailing Address - Country:US
Mailing Address - Phone:248-932-8475
Mailing Address - Fax:
Practice Address - Street 1:19855 W OUTER DR
Practice Address - Street 2:STE 104
Practice Address - City:DEARBORN
Practice Address - State:MI
Practice Address - Zip Code:48124
Practice Address - Country:US
Practice Address - Phone:313-274-5840
Practice Address - Fax:313-274-8277
Is Sole Proprietor?:No
Enumeration Date:2006-12-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI101615101YA0400X
MI68010698351041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Not Answered1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIOM51380Medicare ID - Type Unspecified