Individual
MR. JOHNNY ANDERSON III
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LLMSW
Contact information
Practice address
10032 SHAVER RD, PORTAGE, MI 49024-6738
(269) 543-7776
Mailing address
2206 BENDER RD, PORTAGE, MI 49002-1504
(269) 543-7776
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
Primary
6851112863
MI
Other
Enumeration date
06/21/2024
Last updated
06/21/2024
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