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General NPI Number Information
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NPI Number | 1043934755
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Entity Type | Individual
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Provider Name | ANGELA LALYNN MATTHEWS LLMSW-CLINICAL
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Gender | Female
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Dates
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Enumeration Date | 09/27/2022
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Last Update Date | 09/27/2022
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Provider Practice Location Address
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Address Line | 3181 PRAIRIE ST SW STE 114
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City | GRANDVILLE
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State | MI
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Zip | 49418-2097
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Country | US
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Telephone | 616-256-0196
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Fax |
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Provider Business Mailing Address
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Address Line | 1424 GUENTHER AVE
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City | LANSING
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State | MI
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Zip | 48917-8593
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Country | US
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Telephone | 810-334-8780
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 6851107251
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License Number State | MI
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