Individual
MR. ADAM LEE ANASTASOFF
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.A., L.P.C.
Contact information
Practice address
13316 IDA CENTER RD, IDA, MI 48140-9722
(734) 347-4950
Mailing address
13316 IDA CENTER RD, IDA, MI 48140-9722
(734) 347-4950
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
6401011875
MI
101YM0800X
Mental Health Counselor
6401011875
MI
101YP2500X
Professional Counselor
Primary
6401011875
MI
106H00000X
Marriage & Family Therapist
6401011875
MI
Other
Enumeration date
01/07/2011
Last updated
06/22/2015
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