Provider Demographics
NPI:1316451560
Name:LING, ANTA LUTZ (PHD, CADC, SAP)
Entity type:Individual
Prefix:DR
First Name:ANTA
Middle Name:LUTZ
Last Name:LING
Suffix:
Gender:F
Credentials:PHD, CADC, SAP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1128 S WESTNEDGE AVE
Mailing Address - Street 2:
Mailing Address - City:KALAMAZOO
Mailing Address - State:MI
Mailing Address - Zip Code:49008-1350
Mailing Address - Country:US
Mailing Address - Phone:269-552-9134
Mailing Address - Fax:
Practice Address - Street 1:1128 S WESTNEDGE AVE
Practice Address - Street 2:
Practice Address - City:KALAMAZOO
Practice Address - State:MI
Practice Address - Zip Code:49008-1350
Practice Address - Country:US
Practice Address - Phone:269-552-9134
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-11-27
Last Update Date:2017-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MISA0390142101YA0400X, 405300000X
MI12821101YA0400X
MI2-00443101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No405300000XOther Service ProvidersPrevention Professional