Provider Demographics
NPI:1700397577
Name:HOLBROOK, ANGELA JO (LSW, CDCA)
Entity Type:Individual
Prefix:
First Name:ANGELA
Middle Name:JO
Last Name:HOLBROOK
Suffix:
Gender:F
Credentials:LSW, CDCA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2540 CARROLL EASTERN RD
Mailing Address - Street 2:
Mailing Address - City:CARROLL
Mailing Address - State:OH
Mailing Address - Zip Code:43112-9647
Mailing Address - Country:US
Mailing Address - Phone:740-438-7034
Mailing Address - Fax:
Practice Address - Street 1:201 S COLUMBUS ST
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:OH
Practice Address - Zip Code:43130-4315
Practice Address - Country:US
Practice Address - Phone:740-687-4500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-10-19
Last Update Date:2017-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH1701288104100000X
OHS.1701288104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker