Individual
ANGELA GHOLSTON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
2925 RUSSELL ST, DETROIT, MI 48207-4825
(313) 396-5300
(313) 396-5353
Mailing address
2925 RUSSELL ST, DETROIT, MI 48207-4825
(313) 396-5300
(313) 396-5353
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
Primary
6802088698
MI
Other
Enumeration date
05/29/2014
Last updated
11/17/2015
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