Healthcare Provider Details

I. General information

NPI: 1023556149
Provider Name (Legal Business Name): ANGELA MARIE KIRKER LISW-S, LICDC-CS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/09/2017
Last Update Date: 12/29/2025
Certification Date: 12/29/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

538 MAIN ST STE 309
COSHOCTON OH
43812-1612
US

IV. Provider business mailing address

1136 ORCHARD ST
COSHOCTON OH
43812-1743
US

V. Phone/Fax

Practice location:
  • Phone: 740-202-9754
  • Fax: 740-870-2541
Mailing address:
  • Phone: 740-202-9754
  • Fax: 740-870-2541

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberLICDC.161586
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberI.1700556-SUPV
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: