Healthcare Provider Details

I. General information

NPI: 1376973537
Provider Name (Legal Business Name): ANGELA CILLEY LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/25/2013
Last Update Date: 06/13/2023
Certification Date: 06/13/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5103 EASTMAN AVE STE 117
MIDLAND MI
48640-6723
US

IV. Provider business mailing address

5103 EASTMAN AVE STE 117
MIDLAND MI
48640-6723
US

V. Phone/Fax

Practice location:
  • Phone: 989-455-8214
  • Fax:
Mailing address:
  • Phone: 989-455-8214
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number6801090381
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: