Provider Demographics
NPI:1891255782
Name:ANDERSON, DEMETRIUS LEVANCE SR (LPC CSW)
Entity Type:Individual
Prefix:MR
First Name:DEMETRIUS
Middle Name:LEVANCE
Last Name:ANDERSON
Suffix:SR
Gender:M
Credentials:LPC CSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7732 N 80TH ST
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53223-3810
Mailing Address - Country:US
Mailing Address - Phone:414-477-4506
Mailing Address - Fax:
Practice Address - Street 1:7732 N 80TH ST
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53223-3810
Practice Address - Country:US
Practice Address - Phone:414-477-4506
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-03-25
Last Update Date:2019-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI3761-226101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health