Provider Demographics
NPI:1598411332
Name:TAYLOR, ANGELA DAWN (LLBSW)
Entity Type:Individual
Prefix:
First Name:ANGELA
Middle Name:DAWN
Last Name:TAYLOR
Suffix:
Gender:F
Credentials:LLBSW
Other - Prefix:
Other - First Name:ANGELA
Other - Middle Name:DAWN
Other - Last Name:SHAVALIA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2715 S TOWNLINE RD
Mailing Address - Street 2:
Mailing Address - City:HOUGHTON LAKE
Mailing Address - State:MI
Mailing Address - Zip Code:48629-9294
Mailing Address - Country:US
Mailing Address - Phone:231-620-3137
Mailing Address - Fax:
Practice Address - Street 1:2715 S TOWNLINE RD
Practice Address - Street 2:
Practice Address - City:HOUGHTON LAKE
Practice Address - State:MI
Practice Address - Zip Code:48629-9294
Practice Address - Country:US
Practice Address - Phone:231-620-3137
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-03-01
Last Update Date:2022-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68520932001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical