Provider Demographics
NPI:1497166482
Name:NIYONSENGA, ANGELA (LMSW)
Entity Type:Individual
Prefix:
First Name:ANGELA
Middle Name:
Last Name:NIYONSENGA
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:ANGELA
Other - Middle Name:
Other - Last Name:NIYONSENGA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LMSW
Mailing Address - Street 1:8748 RIO VISTA ST
Mailing Address - Street 2:
Mailing Address - City:BRIGHTON
Mailing Address - State:MI
Mailing Address - Zip Code:48116-2016
Mailing Address - Country:US
Mailing Address - Phone:810-243-2539
Mailing Address - Fax:
Practice Address - Street 1:142 BRIGHTON LAKE RD
Practice Address - Street 2:
Practice Address - City:BRIGHTON
Practice Address - State:MI
Practice Address - Zip Code:48116-1738
Practice Address - Country:US
Practice Address - Phone:810-243-2539
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-05-13
Last Update Date:2023-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6801094451041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical