Provider Demographics
NPI:1639547557
Name:WINSTON, ANGELIQUE SHERELL (LISW-S)
Entity Type:Individual
Prefix:MRS
First Name:ANGELIQUE
Middle Name:SHERELL
Last Name:WINSTON
Suffix:
Gender:F
Credentials:LISW-S
Other - Prefix:MS
Other - First Name:ANGELIQUE
Other - Middle Name:SHERELL
Other - Last Name:SAMUEL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:6147 STATE ROUTE 122 STE 200
Mailing Address - Street 2:
Mailing Address - City:MIDDLETOWN
Mailing Address - State:OH
Mailing Address - Zip Code:45005-5201
Mailing Address - Country:US
Mailing Address - Phone:513-261-3500
Mailing Address - Fax:513-261-3509
Practice Address - Street 1:6147 STATE ROUTE 122 STE 200
Practice Address - Street 2:
Practice Address - City:MIDDLETOWN
Practice Address - State:OH
Practice Address - Zip Code:45005-5201
Practice Address - Country:US
Practice Address - Phone:513-261-3500
Practice Address - Fax:513-261-3509
Is Sole Proprietor?:No
Enumeration Date:2015-09-09
Last Update Date:2022-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHI.10002571041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0156984Medicaid