Active NPI
Michael A Anderson, CDCA
- Addiction (Substance Use Disorder) Counselor
- Canton, OH
National Provider Identifier
1699028159
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Addiction (Substance Use Disorder) Counselor
- License
- 110791
- Practice address
- 1341 Market Ave N
Canton, OH 44714-2605 - Phone
- (330) 453-8252
- Fax
- (330) 452-4655
- NPI assigned
- Oct 22, 2012
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Addiction (Substance Use Disorder) Counselor | 101YA0400X | 110791 | OH | Primary |
Addresses
Primary practice location
1341 Market Ave N
Canton, OH 44714-2605
Mailing address
1341 Market Ave N
Canton, OH 44714-2605
Phone (330) 453-8252
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 2901131 | Medicaid | OH |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 110791 | OH | MD | Licensed Practical Nurse |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1350864000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1350864000000",
"number": "1699028159",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1341 MARKET AVE N",
"city": "CANTON",
"state": "OH",
"postal_code": "447142605",
"telephone_number": "330-453-8252",
"fax_number": "330-452-4655"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1341 MARKET AVE N",
"city": "CANTON",
"state": "OH",
"postal_code": "447142605",
"telephone_number": "330-453-8252",
"fax_number": "330-452-4655"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ANDERSON",
"first_name": "MICHAEL",
"middle_name": "A",
"name_prefix": "Mr.",
"credential": "CDCA",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2012-10-22",
"last_updated": "2012-10-22",
"status": "A"
},
"taxonomies": [
{
"code": "101YA0400X",
"taxonomy_group": "",
"desc": "Counselor, Addiction (Substance Use Disorder)",
"state": "OH",
"license": "110791",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "2901131",
"state": "OH"
}
],
"endpoints": [],
"other_names": []
}Other providers in Canton, OH
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 22, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.