Provider Demographics
NPI:1912667270
Name:FARRAH, ANGELA LORIENA
Entity type:Individual
Prefix:
First Name:ANGELA
Middle Name:LORIENA
Last Name:FARRAH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:38124 YONKERS DR
Mailing Address - Street 2:
Mailing Address - City:STERLING HEIGHTS
Mailing Address - State:MI
Mailing Address - Zip Code:48310-3455
Mailing Address - Country:US
Mailing Address - Phone:586-419-5701
Mailing Address - Fax:
Practice Address - Street 1:44225 W 12 MILE RD STE C-106
Practice Address - Street 2:
Practice Address - City:NOVI
Practice Address - State:MI
Practice Address - Zip Code:48377-2640
Practice Address - Country:US
Practice Address - Phone:248-277-3005
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-12-28
Last Update Date:2021-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6451022016101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional