=====================================================
General NPI Number Information
=====================================================
NPI Number | 1699233064
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ANGELICA REYES ARAOS LIMITED LICENSE MSW
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/05/2019
-----------------------------------------------------
Last Update Date | 03/05/2019
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2399 E WALTON BLVD
-----------------------------------------------------
City | AUBURN HILLS
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 48326-1955
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 248-475-6300
-----------------------------------------------------
Fax | 248-475-6403
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 5440 KIMBERLY DR
-----------------------------------------------------
City | GRAND BLANC
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 48439-5164
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 810-516-8949
-----------------------------------------------------
Fax | 810-694-3518
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1041C0700X
-----------------------------------------------------
Taxonomy Name | Clinical Social Worker
-----------------------------------------------------
License Number | 6801098488
-----------------------------------------------------
License Number State | MI
-----------------------------------------------------