Individual
ANGELA D OLD
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LISW-CP
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
20917
IL
1041C0700X
Clinical Social Worker
Primary
11110
SC
1041C0700X
Clinical Social Worker
149008717
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
11110
LISW-CP
SC
01
—
149008717
LCSW
IL
01
—
1636956
BCBS
IL
01
—
CAQH
11693514
IL
Enumeration date
02/01/2007
Last updated
12/07/2023
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