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General NPI Number Information
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NPI Number | 1144731316
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Entity Type | Individual
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Provider Name | ANGELA MARIE OVERHOLT LCSW
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Gender | Female
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Dates
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Enumeration Date | 10/16/2017
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Last Update Date | 10/16/2017
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Provider Practice Location Address
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Address Line | 700 S GREGORY ST STE A
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City | URBANA
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State | IL
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Zip | 61801-3622
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Country | US
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Telephone | 217-351-4796
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Fax | 217-607-5432
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Provider Business Mailing Address
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Address Line | 1101 CLIFFORD DR APT 7
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City | URBANA
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State | IL
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Zip | 61802-6815
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Country | US
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Telephone | 217-840-6476
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 149.019395
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License Number State | IL
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