Basic Information
| Provider Information | |||||||||
| NPI: | 1801107933 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | POWELL | ||||||||
| FirstName: | ANGELO | ||||||||
| MiddleName: | CARL | ||||||||
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| Credential: | BSW | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2280 E GRAND RIVER AVE | ||||||||
| Address2: | |||||||||
| City: | HOWELL | ||||||||
| State: | MI | ||||||||
| PostalCode: | 488438503 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5175480081 | ||||||||
| FaxNumber: | 5175480498 | ||||||||
| Practice Location | |||||||||
| Address1: | 3760 CLEARY DR | ||||||||
| Address2: | |||||||||
| City: | HOWELL | ||||||||
| State: | MI | ||||||||
| PostalCode: | 488438542 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5175480081 | ||||||||
| FaxNumber: | 5175480498 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/23/2010 | ||||||||
| LastUpdateDate: | 06/23/2010 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 104100000X | 6802064577 | MI | Y | Behavioral Health & Social Service Providers | Social Worker |
No ID Information.