Provider Demographics
NPI:1669254124
Name:COPPLE, ANNA M (LLMSW)
Entity type:Individual
Prefix:
First Name:ANNA
Middle Name:M
Last Name:COPPLE
Suffix:
Gender:F
Credentials:LLMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:670 GRISWOLD ST STE 100
Mailing Address - Street 2:
Mailing Address - City:NORTHVILLE
Mailing Address - State:MI
Mailing Address - Zip Code:48167-2687
Mailing Address - Country:US
Mailing Address - Phone:313-748-8769
Mailing Address - Fax:
Practice Address - Street 1:670 GRISWOLD ST STE 100
Practice Address - Street 2:
Practice Address - City:NORTHVILLE
Practice Address - State:MI
Practice Address - Zip Code:48167-2687
Practice Address - Country:US
Practice Address - Phone:313-748-8769
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-10-19
Last Update Date:2023-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68511175201041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical