MEDICARE: ARCH ANGEL SERVICES

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1093453615
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ARCH ANGEL SERVICES

Provider Business Mailing Address
First Line	:	20 S 3RD ST STE 210
Second Line	:
City	:	COLUMBUS
State	:	OH
Zip	:	43215-4206
Country	:	US
Telephone Number	:	833-427-2264
Fax Number	:	773-260-1479

Provider Business Practice Location Address
First Line	:	4182 WORTH AVE STE 1-115
Second Line	:
City	:	COLUMBUS
State	:	OH
Zip	:	43219-1535
Country	:	US
Telephone Number	:	312-474-6189
Fax Number	:

Authorized Official
Title or Position	:	CEO/OWNER
Name	:	ANTUAN DURALL WILBON
Credential	:
Telephone Number	:	708-743-2608

Provider Enumeration Date	:	05/24/2022
Last Update Date	:	07/11/2023

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Directions to “ARCH ANGEL SERVICES ” Practice Location

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