Provider Demographics
NPI:1063796910
Name:GARR, ANITA MARIE
Entity type:Individual
Prefix:MS
First Name:ANITA
Middle Name:MARIE
Last Name:GARR
Suffix:
Gender:F
Credentials:
Other - Prefix:MS
Other - First Name:ANITA
Other - Middle Name:MARIE
Other - Last Name:GARR
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LMSW
Mailing Address - Street 1:21885 DUNHAM ROAD
Mailing Address - Street 2:STE 2
Mailing Address - City:CLINTON TOWNSHIP
Mailing Address - State:MI
Mailing Address - Zip Code:48036
Mailing Address - Country:US
Mailing Address - Phone:586-306-3945
Mailing Address - Fax:
Practice Address - Street 1:21885 DUNHAM RD
Practice Address - Street 2:STE 2
Practice Address - City:CLINTON TOWNSHIP
Practice Address - State:MI
Practice Address - Zip Code:48036-1030
Practice Address - Country:US
Practice Address - Phone:586-306-3945
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-10-10
Last Update Date:2011-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010632231041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical