Provider Demographics
NPI:1740763937
Name:MCALLISTER, ANGELA MARIE (CADACIV, ICAADC)
Entity Type:Individual
Prefix:
First Name:ANGELA
Middle Name:MARIE
Last Name:MCALLISTER
Suffix:
Gender:F
Credentials:CADACIV, ICAADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:706 GREEN BLVD
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:IN
Mailing Address - Zip Code:47001-1506
Mailing Address - Country:US
Mailing Address - Phone:812-584-3615
Mailing Address - Fax:812-720-3907
Practice Address - Street 1:706 GREEN BLVD
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:IN
Practice Address - Zip Code:47001-1506
Practice Address - Country:US
Practice Address - Phone:812-584-3615
Practice Address - Fax:812-720-3907
Is Sole Proprietor?:No
Enumeration Date:2018-09-13
Last Update Date:2021-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHLICDC.161465101YA0400X
INCIV-1741101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)