Provider Demographics
NPI:1801878202
Name:ANDERSON, DAVID WILLIAM (LPC)
Entity type:Individual
Prefix:MR
First Name:DAVID
Middle Name:WILLIAM
Last Name:ANDERSON
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:2091 PROFESSIONAL DR STE I-1
Mailing Address - Street 2:
Mailing Address - City:FLINT
Mailing Address - State:MI
Mailing Address - Zip Code:48532-3657
Mailing Address - Country:US
Mailing Address - Phone:810-732-1652
Mailing Address - Fax:810-732-1735
Practice Address - Street 1:2091 PROFESSIONAL DR STE I-1
Practice Address - Street 2:
Practice Address - City:FLINT
Practice Address - State:MI
Practice Address - Zip Code:48532-3657
Practice Address - Country:US
Practice Address - Phone:810-732-1652
Practice Address - Fax:810-732-1735
Is Sole Proprietor?:No
Enumeration Date:2005-11-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6401005763101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1009923OtherHEALTH ADVANTAGE NETWORK
MI230193OtherHEALTH ALLIANCE PLAN
MI0996438OtherHEALTH PLUS
MI1009923OtherMCLAREN HEALTH PLAN
MI7509139490OtherBCBS OF MICHIGAN