Provider Demographics
NPI:1003934936
Name:ROSS-BERRY, ANGELINA JOYCE (FAODP)
Entity Type:Individual
Prefix:MRS
First Name:ANGELINA
Middle Name:JOYCE
Last Name:ROSS-BERRY
Suffix:
Gender:F
Credentials:FAODP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1223 GLYNN CT
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48202-1426
Mailing Address - Country:US
Mailing Address - Phone:313-742-8371
Mailing Address - Fax:313-971-9950
Practice Address - Street 1:514 ALGER ST
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48202-2106
Practice Address - Country:US
Practice Address - Phone:313-871-9940
Practice Address - Fax:313-871-9950
Is Sole Proprietor?:No
Enumeration Date:2007-03-27
Last Update Date:2007-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)