Provider Demographics
NPI:1285065508
Name:BUCHANAN, ANQUELLA EUNISE (MA LLPC)
Entity type:Individual
Prefix:MRS
First Name:ANQUELLA
Middle Name:EUNISE
Last Name:BUCHANAN
Suffix:
Gender:F
Credentials:MA LLPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6221 BRUSH ST
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48202-3209
Mailing Address - Country:US
Mailing Address - Phone:313-874-7014
Mailing Address - Fax:313-874-7015
Practice Address - Street 1:6221 BRUSH ST
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48202-3209
Practice Address - Country:US
Practice Address - Phone:313-874-7014
Practice Address - Fax:313-874-7015
Is Sole Proprietor?:No
Enumeration Date:2013-12-12
Last Update Date:2013-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6401009372101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional