Healthcare Provider Details

I. General information

NPI: 1487911483
Provider Name (Legal Business Name): ANGELA KAY HUSBAND LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/13/2012
Last Update Date: 11/03/2023
Certification Date: 11/03/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7824 E SAINT HUBERTS TRL
HESPERIA MI
49421-6736
US

IV. Provider business mailing address

7824 E SAINT HUBERTS TRL
HESPERIA MI
49421-6736
US

V. Phone/Fax

Practice location:
  • Phone: 510-334-5950
  • Fax: 510-460-7139
Mailing address:
  • Phone: 510-334-5950
  • Fax: 510-460-7139

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number149015091
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number6795
License Number StateTN
# 3
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number6801116380
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: