Provider Demographics
NPI:1609932177
Name:SMITH, ANGELA JOELLE (MSW)
Entity Type:Individual
Prefix:MS
First Name:ANGELA
Middle Name:JOELLE
Last Name:SMITH
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:419 MOORES RIVER DR
Mailing Address - Street 2:
Mailing Address - City:LANSING
Mailing Address - State:MI
Mailing Address - Zip Code:48910-1435
Mailing Address - Country:US
Mailing Address - Phone:517-485-0007
Mailing Address - Fax:
Practice Address - Street 1:1505 WATERFORD PKWY
Practice Address - Street 2:
Practice Address - City:SAINT JOHNS
Practice Address - State:MI
Practice Address - Zip Code:48879-9630
Practice Address - Country:US
Practice Address - Phone:989-227-9000
Practice Address - Fax:989-224-0058
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6801086317104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker