Provider Demographics
NPI:1548658891
Name:DUNCAN, ANNEBELLE VERETTE (MA, RSST)
Entity type:Individual
Prefix:
First Name:ANNEBELLE
Middle Name:VERETTE
Last Name:DUNCAN
Suffix:
Gender:F
Credentials:MA, RSST
Other - Prefix:
Other - First Name:ANNE
Other - Middle Name:
Other - Last Name:DUNCAN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MA, RSST
Mailing Address - Street 1:1852 W GRAND BLVD
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48208-1006
Mailing Address - Country:US
Mailing Address - Phone:313-894-8444
Mailing Address - Fax:313-894-1274
Practice Address - Street 1:13560 E MCNICHOLS RD
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48205-3426
Practice Address - Country:US
Practice Address - Phone:313-451-3425
Practice Address - Fax:313-451-3425
Is Sole Proprietor?:No
Enumeration Date:2015-01-08
Last Update Date:2019-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI171R00000X
MI68030886267101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No171R00000XOther Service ProvidersInterpreter
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1326416876Medicaid