Healthcare Provider Details

I. General information

NPI: 1912667270
Provider Name (Legal Business Name): ANGELA LORIENA FARRAH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/28/2021
Last Update Date: 12/28/2021
Certification Date: 12/28/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

44225 W 12 MILE RD STE C-106
NOVI MI
48377-2640
US

IV. Provider business mailing address

38124 YONKERS DR
STERLING HEIGHTS MI
48310-3455
US

V. Phone/Fax

Practice location:
  • Phone: 248-277-3005
  • Fax:
Mailing address:
  • Phone: 586-419-5701
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number6451022016
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: