Healthcare Provider Details

I. General information

NPI: 1922266501
Provider Name (Legal Business Name): ANGELA M. WILLIAMS LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/29/2008
Last Update Date: 06/11/2025
Certification Date: 06/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4250 E FLORIAN AVE BLDG 1
MESA AZ
85206-2797
US

IV. Provider business mailing address

4250 E FLORIAN AVE BLDG 1
MESA AZ
85206-2797
US

V. Phone/Fax

Practice location:
  • Phone: 480-628-5643
  • Fax:
Mailing address:
  • Phone: 480-628-5643
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLCSW-23047
License Number StateAZ

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier104151
Identifier TypeMEDICAID
Identifier StateAZ
Identifier Issuer

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: