Individual provider Active NPI

Angela Marie Watley

  • Mental Health Counselor
  • Detroit, MI
National Provider Identifier
1205339041
Registry record updated May 2, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Mental Health CounselorTaxonomy code 101YM0800X
License
6401222327 Issued in MI
Practice address
2925 Russell St
Detroit, MI 48207-4825
Phone
(313) 396-5300
NPI assigned
Mar 16, 2018
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 2, 2022

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Mental Health Counselor 101YM0800X 6401222327 MI Primary

Addresses

Primary practice location

2925 Russell St
Detroit, MI 48207-4825

Mailing address

2925 Russell St
Detroit, MI 48207-4825
Phone (313) 396-5300

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MI
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: No
  • Power mobility devices: No
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20240209002161 MI Practitioner - Mental Health Counselor 6103269816 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
6401222327MIMDMental Health Counselor

Practice roles

OrganizationSpecialtyStatusNew patients
Team Wellness Center CurrentSince Jan 2, 2024 Accepting new patients
Team Mental Health Services Inc. CurrentSince Jan 2, 2024 Accepting new patients

Locations

290 Town Center Dr
Ste 400
Dearborn, MI 48126
Phone (248) 763-5289

2925 Russell St
Detroit, MI 48207
Phone (313) 462-4714

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1521158400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1651449600000",
    "number": "1205339041",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2925 RUSSELL ST",
            "city": "DETROIT",
            "state": "MI",
            "postal_code": "482074825",
            "telephone_number": "313-396-5300"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2925 RUSSELL ST",
            "city": "DETROIT",
            "state": "MI",
            "postal_code": "482074825",
            "telephone_number": "313-396-5300"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WATLEY",
        "first_name": "ANGELA",
        "middle_name": "MARIE",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2018-03-16",
        "last_updated": "2022-05-02",
        "certification_date": "2022-05-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "MI",
            "license": "6401222327",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Detroit, MI

Sources for this page

Verify at the official NPI Registry.