Provider Demographics
NPI:1295541142
Name:CROOMS, ANGELA LOREEN
Entity type:Individual
Prefix:
First Name:ANGELA
Middle Name:LOREEN
Last Name:CROOMS
Suffix:
Gender:F
Credentials:
Other - Prefix:MS
Other - First Name:ANGELA
Other - Middle Name:LOREEN
Other - Last Name:CROOMS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:26440 WESTPHAL ST APT 110
Mailing Address - Street 2:
Mailing Address - City:DEARBORN HEIGHTS
Mailing Address - State:MI
Mailing Address - Zip Code:48127-3775
Mailing Address - Country:US
Mailing Address - Phone:313-296-2020
Mailing Address - Fax:
Practice Address - Street 1:30301 NORTHWESTERN HWY STE 100
Practice Address - Street 2:
Practice Address - City:FARMINGTON HILLS
Practice Address - State:MI
Practice Address - Zip Code:48334-3277
Practice Address - Country:US
Practice Address - Phone:248-837-2089
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-12-05
Last Update Date:2024-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician