Provider Demographics
NPI:1104994904
Name:DOVER, ANITA M (MSW, LMSW, ACSW)
Entity type:Individual
Prefix:MS
First Name:ANITA
Middle Name:M
Last Name:DOVER
Suffix:
Gender:F
Credentials:MSW, LMSW, ACSW
Other - Prefix:
Other - First Name:ANITA
Other - Middle Name:MARIE
Other - Last Name:DOVER KRUG
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LMSW ACSW BCD
Mailing Address - Street 1:2387 S. LINDEN RD
Mailing Address - Street 2:SUITE B108
Mailing Address - City:FLINT
Mailing Address - State:MI
Mailing Address - Zip Code:48532-5443
Mailing Address - Country:US
Mailing Address - Phone:810-732-1459
Mailing Address - Fax:810-733-7689
Practice Address - Street 1:2387 S. LINDEN RD
Practice Address - Street 2:SUITE B108
Practice Address - City:FLINT
Practice Address - State:MI
Practice Address - Zip Code:48532-5443
Practice Address - Country:US
Practice Address - Phone:810-732-1459
Practice Address - Fax:810-733-7689
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-01
Last Update Date:2010-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010155921041C0700X
MI4101005886106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
019879000OtherMAGELLAN
MI8008940090OtherBLUE CROSS BLUE SHIELD
MI042352OtherVALUE OPTIONS
6801015592OtherHEALTH PLUS OF MICHIGAN
MI042352OtherVALUE OPTIONS