Provider Demographics
NPI:1609441005
Name:BONHAM, ANGELA BETH (LMSW)
Entity Type:Individual
Prefix:
First Name:ANGELA
Middle Name:BETH
Last Name:BONHAM
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:ANGELA
Other - Middle Name:BETH
Other - Last Name:MALOUF
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:5014 S STATE RD
Mailing Address - Street 2:
Mailing Address - City:DAVISON
Mailing Address - State:MI
Mailing Address - Zip Code:48423-8753
Mailing Address - Country:US
Mailing Address - Phone:810-424-6254
Mailing Address - Fax:
Practice Address - Street 1:3300 WASHTENAW AVE STE 260
Practice Address - Street 2:
Practice Address - City:ANN ARBOR
Practice Address - State:MI
Practice Address - Zip Code:48104-5184
Practice Address - Country:US
Practice Address - Phone:734-277-7565
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-05-26
Last Update Date:2023-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68011141901041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical