Provider Demographics
NPI:1366760837
Name:WILLIAMS, ANGEL JENELLE (MSW)
Entity type:Individual
Prefix:MRS
First Name:ANGEL
Middle Name:JENELLE
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:ANGEL
Other - Middle Name:JENELLE
Other - Last Name:COLE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSW
Mailing Address - Street 1:6250 W NORTH AVE FL 1
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60639-3861
Mailing Address - Country:US
Mailing Address - Phone:773-622-6218
Mailing Address - Fax:773-622-7440
Practice Address - Street 1:6250W NORTH AVE 1
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60639-3861
Practice Address - Country:US
Practice Address - Phone:773-622-6218
Practice Address - Fax:773-622-7440
Is Sole Proprietor?:Yes
Enumeration Date:2010-05-08
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL149-0135101041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical