Provider Demographics
NPI:1992508154
Name:ANTHONY, FAITH OLIVIA
Entity type:Individual
Prefix:
First Name:FAITH
Middle Name:OLIVIA
Last Name:ANTHONY
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1521 W KILBOURN AVE APT 301
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53233-1720
Mailing Address - Country:US
Mailing Address - Phone:317-954-3197
Mailing Address - Fax:
Practice Address - Street 1:1521 W KILBOURN AVE APT 301
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53233-1720
Practice Address - Country:US
Practice Address - Phone:317-954-3197
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-03-31
Last Update Date:2025-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health