Doctor Name: | ANTHONY JEROME ALLEN |
NPI Number: | 1003023680 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | AAS., CAC II |
License Number: | 820202 |
Business Practice Address: | 12010 Linwood St Detroit, MI - 482061108 |
Business Phone Number: | 3138671090 |
Business Fax Number: | 3138670706 |
Mailing Address: | 5113 Bangor St, DETROIT |
State: | MI |
Postal Code: | 482101760 |
Phone Number: | 3138671090 |
Fax Number: | 3138670706 |
NPI Enumeration Date: | 05/16/2007 |
NPI Last Update Date: | 07/08/2007 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101YA0400X |
License Number: | 820202 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | MI |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | Addiction (Substance Use Disorder) |
Taxonomy Definition: |