Provider Demographics
NPI:1952036592
Name:GARCIA-CRUCES, ANGELICA MELISSA
Entity Type:Individual
Prefix:
First Name:ANGELICA
Middle Name:MELISSA
Last Name:GARCIA-CRUCES
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6287 EGYPT VALLEY AVE NE
Mailing Address - Street 2:
Mailing Address - City:ROCKFORD
Mailing Address - State:MI
Mailing Address - Zip Code:49341-8209
Mailing Address - Country:US
Mailing Address - Phone:616-685-9033
Mailing Address - Fax:
Practice Address - Street 1:6287 EGYPT VALLEY AVE NE
Practice Address - Street 2:
Practice Address - City:ROCKFORD
Practice Address - State:MI
Practice Address - Zip Code:49341-8209
Practice Address - Country:US
Practice Address - Phone:616-685-9033
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-07-18
Last Update Date:2023-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
104100000X
MI68511172451041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker