Provider Demographics
NPI:1043601495
Name:WELCH, ANGELA (LPC)
Entity Type:Individual
Prefix:
First Name:ANGELA
Middle Name:
Last Name:WELCH
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:ANGELA
Other - Middle Name:
Other - Last Name:MAGNUSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:185 44TH ST SW
Mailing Address - Street 2:
Mailing Address - City:GRANDVILLE
Mailing Address - State:MI
Mailing Address - Zip Code:49418-3363
Mailing Address - Country:US
Mailing Address - Phone:609-501-5211
Mailing Address - Fax:
Practice Address - Street 1:185 44TH ST SW
Practice Address - Street 2:
Practice Address - City:GRANDVILLE
Practice Address - State:MI
Practice Address - Zip Code:49418-3363
Practice Address - Country:US
Practice Address - Phone:616-244-2246
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-02-06
Last Update Date:2023-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6401013738101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional