Healthcare Provider Details

I. General information

NPI: 1215965140
Provider Name (Legal Business Name): ANGELA MARIE ADAMS MARTIN MS, LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/29/2006
Last Update Date: 12/11/2024
Certification Date: 12/11/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2328 DALLAS CREEK LN
GREEN COVE SPRINGS FL
32043-8274
US

IV. Provider business mailing address

2328 DALLAS CREEK LN
GREEN COVE SPRINGS FL
32043-8274
US

V. Phone/Fax

Practice location:
  • Phone: 217-898-8160
  • Fax:
Mailing address:
  • Phone: 217-898-8160
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number14381
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number149009865
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: