Provider Demographics
NPI:1083964530
Name:CHESSER, ANGELA (LLMSW)
Entity Type:Individual
Prefix:
First Name:ANGELA
Middle Name:
Last Name:CHESSER
Suffix:
Gender:F
Credentials:LLMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1715 SUTHERLAND DR SE
Mailing Address - Street 2:
Mailing Address - City:KENTWOOD
Mailing Address - State:MI
Mailing Address - Zip Code:49508-3306
Mailing Address - Country:US
Mailing Address - Phone:616-281-4601
Mailing Address - Fax:616-281-9572
Practice Address - Street 1:1715 SUTHERLAND DR SE
Practice Address - Street 2:
Practice Address - City:KENTWOOD
Practice Address - State:MI
Practice Address - Zip Code:49508-3306
Practice Address - Country:US
Practice Address - Phone:616-281-4601
Practice Address - Fax:616-281-9572
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-12
Last Update Date:2019-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6801100329104100000X, 1041C0700X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program