Provider Demographics
NPI:1841697190
Name:BLACK, ANGELIA MICHELLE
Entity type:Individual
Prefix:
First Name:ANGELIA
Middle Name:MICHELLE
Last Name:BLACK
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 1:1881 W ALEXANDER RD UNIT 1127
Mailing Address - Street 2:
Mailing Address - City:NORTH LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89032-9023
Mailing Address - Country:US
Mailing Address - Phone:702-205-9475
Mailing Address - Fax:
Practice Address - Street 1:1881 W ALEXANDER RD UNIT 1127
Practice Address - Street 2:
Practice Address - City:NORTH LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89032-9023
Practice Address - Country:US
Practice Address - Phone:702-205-9475
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-12-02
Last Update Date:2014-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker