Provider Demographics
NPI:1528344371
Name:DILLAWAY, ANNA MARIA (LMSW)
Entity type:Individual
Prefix:
First Name:ANNA
Middle Name:MARIA
Last Name:DILLAWAY
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:ANNA
Other - Middle Name:MARIE
Other - Last Name:DILLAWAY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:35 S JOHNSON ST STE 3C
Mailing Address - Street 2:
Mailing Address - City:PONTIAC
Mailing Address - State:MI
Mailing Address - Zip Code:48341-1662
Mailing Address - Country:US
Mailing Address - Phone:248-333-7222
Mailing Address - Fax:
Practice Address - Street 1:4318 MILLER RD
Practice Address - Street 2:
Practice Address - City:FLINT
Practice Address - State:MI
Practice Address - Zip Code:48507-1267
Practice Address - Country:US
Practice Address - Phone:810-249-9924
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-10-25
Last Update Date:2022-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIC-03219101YA0400X
MI68010962001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)