Provider Demographics
NPI:1952809493
Name:GLADSTONE-HIGHLAND, ANDREW (LMSW)
Entity Type:Individual
Prefix:
First Name:ANDREW
Middle Name:
Last Name:GLADSTONE-HIGHLAND
Suffix:
Gender:M
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23750 BUCKINGHAM ST
Mailing Address - Street 2:
Mailing Address - City:DEARBORN
Mailing Address - State:MI
Mailing Address - Zip Code:48128-1766
Mailing Address - Country:US
Mailing Address - Phone:919-260-8993
Mailing Address - Fax:
Practice Address - Street 1:3200 GREENFIELD RD STE 200
Practice Address - Street 2:
Practice Address - City:DEARBORN
Practice Address - State:MI
Practice Address - Zip Code:48120-1802
Practice Address - Country:US
Practice Address - Phone:313-312-4511
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-01-30
Last Update Date:2023-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6801107016104100000X, 1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker