Healthcare Provider Details

I. General information

NPI: 1578962098
Provider Name (Legal Business Name): ANGELA DENISE DIALLO MA LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/20/2014
Last Update Date: 07/07/2026
Certification Date: 07/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

29201 TELEGRAPH RD
SOUTHFIELD MI
48034-1331
US

IV. Provider business mailing address

28715 GALLOWAY ST
ROSEVILLE MI
48066-4206
US

V. Phone/Fax

Practice location:
  • Phone: 248-213-0501
  • Fax:
Mailing address:
  • Phone: 586-625-9685
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number6401014592
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: