Provider Demographics
NPI:1437887122
Name:ALLEN, ANGELICA (LLMSW)
Entity Type:Individual
Prefix:
First Name:ANGELICA
Middle Name:
Last Name:ALLEN
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 1:6639 CENTURION DR STE 130
Mailing Address - Street 2:
Mailing Address - City:LANSING
Mailing Address - State:MI
Mailing Address - Zip Code:48917-8273
Mailing Address - Country:US
Mailing Address - Phone:517-322-3050
Mailing Address - Fax:517-709-7701
Practice Address - Street 1:6639 CENTURION DR STE 130
Practice Address - Street 2:
Practice Address - City:LANSING
Practice Address - State:MI
Practice Address - Zip Code:48917-8273
Practice Address - Country:US
Practice Address - Phone:517-322-3050
Practice Address - Fax:517-709-7701
Is Sole Proprietor?:No
Enumeration Date:2022-08-10
Last Update Date:2022-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68511143911041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical