Healthcare Provider Details

I. General information

NPI: 1639081185
Provider Name (Legal Business Name): ANGELIQUE SANCHEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/21/2026
Last Update Date: 09/21/2026
Certification Date: 09/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

44644 ANN ARBOR RD W STE C
PLYMOUTH MI
48170-4093
US

IV. Provider business mailing address

3187 20TH ST
WYANDOTTE MI
48192-5429
US

V. Phone/Fax

Practice location:
  • Phone: 313-447-0557
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number6851121828
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: