Provider Demographics
NPI:1295026011
Name:PAYNE, ANGELA S (LLPC)
Entity type:Individual
Prefix:
First Name:ANGELA
Middle Name:S
Last Name:PAYNE
Suffix:
Gender:F
Credentials:LLPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19785 W 12 MILE RD
Mailing Address - Street 2:490
Mailing Address - City:SOUTHFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48076-2584
Mailing Address - Country:US
Mailing Address - Phone:586-703-1514
Mailing Address - Fax:
Practice Address - Street 1:19785 W 12 MILE RD
Practice Address - Street 2:490
Practice Address - City:SOUTHFIELD
Practice Address - State:MI
Practice Address - Zip Code:48076-2584
Practice Address - Country:US
Practice Address - Phone:586-703-1514
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-27
Last Update Date:2011-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6401011146101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health