1104994904 NPI number — MS. ANITA M DOVER MSW, LMSW, ACSW

Table of content: MS. ANITA M DOVER MSW, LMSW, ACSW (NPI 1104994904)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1104994904 NPI number — MS. ANITA M DOVER MSW, LMSW, ACSW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
DOVER
Provider First Name:
ANITA
Provider Middle Name:
M
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
MSW, LMSW, ACSW
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
DOVER KRUG
Provider Other First Name:
ANITA
Provider Other Middle Name:
MARIE
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
LMSW ACSW BCD
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1104994904
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/19/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2387 S. LINDEN RD
Provider Second Line Business Mailing Address:
SUITE B108
Provider Business Mailing Address City Name:
FLINT
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
48532-5443
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
810-732-1459
Provider Business Mailing Address Fax Number:
810-733-7689

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2387 S. LINDEN RD
Provider Second Line Business Practice Location Address:
SUITE B108
Provider Business Practice Location Address City Name:
FLINT
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48532-5443
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
810-732-1459
Provider Business Practice Location Address Fax Number:
810-733-7689
Provider Enumeration Date:
12/01/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 1041C0700X , with the licence number:  6801015592 , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 106H00000X , with the licence number: 4101005886 , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 019879000 . This is a "MAGELLAN" identifier . This identifiers is of the category "OTHER".
  • Identifier: 8008940090 . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 042352 . This is a "VALUE OPTIONS" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 6801015592 . This is a "HEALTH PLUS OF MICHIGAN" identifier . This identifiers is of the category "OTHER".




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