Healthcare Provider Details

I. General information

NPI: 1629524442
Provider Name (Legal Business Name): ANGELA MICHELE POOL LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/31/2016
Last Update Date: 07/25/2024
Certification Date: 07/25/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

405 W MONROE ST
DUNDEE MI
48131-1240
US

IV. Provider business mailing address

PO BOX 26
DUNDEE MI
48131-0026
US

V. Phone/Fax

Practice location:
  • Phone: 734-854-7061
  • Fax:
Mailing address:
  • Phone: 734-854-7061
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number6801100203
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: