Provider Demographics
NPI:1477057206
Name:PETZ, ANGELA (LPC)
Entity type:Individual
Prefix:
First Name:ANGELA
Middle Name:
Last Name:PETZ
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:ANGELA
Other - Middle Name:
Other - Last Name:RICCIARDI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPC
Mailing Address - Street 1:51 CASCADE LN
Mailing Address - Street 2:
Mailing Address - City:WATERFORD
Mailing Address - State:MI
Mailing Address - Zip Code:48327-3873
Mailing Address - Country:US
Mailing Address - Phone:248-892-9055
Mailing Address - Fax:
Practice Address - Street 1:2550 S TELEGRAPH RD STE 250
Practice Address - Street 2:
Practice Address - City:BLOOMFIELD HILLS
Practice Address - State:MI
Practice Address - Zip Code:48302-0909
Practice Address - Country:US
Practice Address - Phone:248-322-0003
Practice Address - Fax:248-322-0006
Is Sole Proprietor?:Yes
Enumeration Date:2018-03-19
Last Update Date:2018-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6401007031101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional