Healthcare Provider Details

I. General information

NPI: 1093288029
Provider Name (Legal Business Name): ANGELA MICHELLE MESENBURG LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/02/2019
Last Update Date: 06/18/2026
Certification Date: 06/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

24990 FOY RD
COVINGTON MI
49919-9016
US

IV. Provider business mailing address

24990 FOY RD
COVINGTON MI
49919-9016
US

V. Phone/Fax

Practice location:
  • Phone: 419-921-6531
  • Fax: 616-469-1645
Mailing address:
  • Phone: 419-921-6531
  • Fax: 616-469-1645

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number6801119021
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: