Provider Demographics
NPI:1891835062
Name:ANGEL COUNSELING INC.
Entity Type:Organization
Organization Name:ANGEL COUNSELING INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT AND CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:GIAWANNA
Authorized Official - Middle Name:MONNETTE
Authorized Official - Last Name:PETERSON-ROCHON
Authorized Official - Suffix:
Authorized Official - Credentials:LMSW,CAAC
Authorized Official - Phone:313-533-5652
Mailing Address - Street 1:26847 GRAND RIVER AVE
Mailing Address - Street 2:
Mailing Address - City:REDFORD
Mailing Address - State:MI
Mailing Address - Zip Code:48240-1544
Mailing Address - Country:US
Mailing Address - Phone:313-533-5652
Mailing Address - Fax:313-533-5644
Practice Address - Street 1:26847 GRAND RIVER AVE
Practice Address - Street 2:
Practice Address - City:REDFORD
Practice Address - State:MI
Practice Address - Zip Code:48240-1544
Practice Address - Country:US
Practice Address - Phone:313-533-5652
Practice Address - Fax:313-533-5644
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-07
Last Update Date:2009-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010831691041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0896890OtherBLUE CROSS BLUE SHIELD
MI0P03580Medicare PIN
MI0896890OtherBLUE CROSS BLUE SHIELD