Provider Demographics
NPI:1821107905
Name:MCGUIRE, ANGELA ELAINE (LMSW)
Entity Type:Individual
Prefix:
First Name:ANGELA
Middle Name:ELAINE
Last Name:MCGUIRE
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2930 NOBLE RD
Mailing Address - Street 2:
Mailing Address - City:WILLIAMSTON
Mailing Address - State:MI
Mailing Address - Zip Code:48895-9527
Mailing Address - Country:US
Mailing Address - Phone:517-303-5734
Mailing Address - Fax:
Practice Address - Street 1:11653 HARTEL RD
Practice Address - Street 2:SUITE 3400
Practice Address - City:GRAND LEDGE
Practice Address - State:MI
Practice Address - Zip Code:48837-9190
Practice Address - Country:US
Practice Address - Phone:517-627-7118
Practice Address - Fax:517-627-7116
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-30
Last Update Date:2011-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010572491041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI118508000OtherMAGELLAN MIS PIN
MI1007889OtherMCLAREN PIN
MI0891941OtherBCBS PIN
MI042262OtherVALUE OPTIONS MHS PIN
MI1007889OtherMCLAREN PIN