Provider Demographics
NPI:1841727310
Name:ADAMS-WILTZ, ANGELA
Entity type:Individual
Prefix:
First Name:ANGELA
Middle Name:
Last Name:ADAMS-WILTZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 21
Mailing Address - Street 2:
Mailing Address - City:MELVILLE
Mailing Address - State:LA
Mailing Address - Zip Code:71353-0021
Mailing Address - Country:US
Mailing Address - Phone:318-517-1355
Mailing Address - Fax:
Practice Address - Street 1:1238 EDITH ST
Practice Address - Street 2:
Practice Address - City:OPELOUSAS
Practice Address - State:LA
Practice Address - Zip Code:70570-5917
Practice Address - Country:US
Practice Address - Phone:337-942-9943
Practice Address - Fax:337-942-9943
Is Sole Proprietor?:Yes
Enumeration Date:2017-05-16
Last Update Date:2017-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health