Provider Demographics
NPI:1043934755
Name:MATTHEWS, ANGELA LALYNN (LLMSW-CLINICAL)
Entity Type:Individual
Prefix:MISS
First Name:ANGELA
Middle Name:LALYNN
Last Name:MATTHEWS
Suffix:
Gender:F
Credentials:LLMSW-CLINICAL
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1424 GUENTHER AVE
Mailing Address - Street 2:
Mailing Address - City:LANSING
Mailing Address - State:MI
Mailing Address - Zip Code:48917-8593
Mailing Address - Country:US
Mailing Address - Phone:810-334-8780
Mailing Address - Fax:
Practice Address - Street 1:3181 PRAIRIE ST SW STE 114
Practice Address - Street 2:
Practice Address - City:GRANDVILLE
Practice Address - State:MI
Practice Address - Zip Code:49418-2097
Practice Address - Country:US
Practice Address - Phone:616-256-0196
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-09-27
Last Update Date:2022-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68511072511041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical