Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YM0800X | Mental Health Counselor | 6401009024 | MI |
NPI | 1003015876 |
---|---|
Provider Name | Mrs. Dana Kay Anderson |
First Address | Grand Rapids, MI 49503-1201 |
Second Address | Grand Rapids, MI 49503-1201 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/07/2007 |
Last Update Date | 12/07/2007 |