Provider Demographics
NPI:1902331200
Name:FREEMAN, ANISA (MBA, MSW, CADC, CPRM)
Entity Type:Individual
Prefix:
First Name:ANISA
Middle Name:
Last Name:FREEMAN
Suffix:
Gender:F
Credentials:MBA, MSW, CADC, CPRM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:34771 MORAVIAN DR APT 112
Mailing Address - Street 2:
Mailing Address - City:STERLING HEIGHTS
Mailing Address - State:MI
Mailing Address - Zip Code:48312-5444
Mailing Address - Country:US
Mailing Address - Phone:616-890-9387
Mailing Address - Fax:
Practice Address - Street 1:34771 MORAVIAN DR APT 112
Practice Address - Street 2:
Practice Address - City:STERLING HEIGHTS
Practice Address - State:MI
Practice Address - Zip Code:48312-5444
Practice Address - Country:US
Practice Address - Phone:616-890-9387
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-04-24
Last Update Date:2020-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YA0400X
MI68011081461041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)