Healthcare Provider Details

I. General information

NPI: 1336076744
Provider Name (Legal Business Name): ANGELA ABBOTT MS, LAC, LCADC, CCTP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/07/2026
Last Update Date: 05/07/2026
Certification Date: 05/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

426 ADAMSTON RD
BRICK NJ
08723-8036
US

IV. Provider business mailing address

426 ADAMSTON RD
BRICK NJ
08723-8036
US

V. Phone/Fax

Practice location:
  • Phone: 732-814-6196
  • Fax:
Mailing address:
  • Phone: 732-814-6196
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number37AC00903800
License Number StateNJ
# 2
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number37LC00409800
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: