Individual provider Active NPI

Angela Walker, LSCW, LCAC

  • Clinical Social Worker
  • Fort Wayne, IN
National Provider Identifier
1124563788
Registry record updated Apr 3, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
34007712A Issued in IN
Practice address
4109 W Jefferson Blvd
Ste a
Fort Wayne, IN 46804-6894
Phone
(260) 486-5251
Fax
(260) 486-5058
NPI assigned
Jan 5, 2017
Last updated
Apr 3, 2024By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 3, 2024

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Addiction (Substance Use Disorder) Counselor 101YA0400X 87001240A IN
Clinical Social Worker 1041C0700X 34007712A IN Primary

Addresses

Primary practice location

4109 W Jefferson Blvd
Ste a
Fort Wayne, IN 46804-6894

Mailing address

4109 W Jefferson Blvd
Ste a
Fort Wayne, IN 46804-6894
Phone (260) 486-5251

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
87001240AINMDAddiction (Substance Use Disorder) Counselor

Practice roles

OrganizationSpecialtyStatusNew patients
Consulting & Counseling Associates, LLC Clinical CurrentSince May 1, 2021 Accepting new patients

Locations

4109 W Jefferson Blvd
Ste A
Fort Wayne, IN 46804
Phone (260) 486-5251

4214 Hobson Ct
Fort Wayne, IN 46815
Phone (260) 486-5251

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1483574400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1712102400000",
    "number": "1124563788",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4109 W JEFFERSON BLVD",
            "address_2": "STE A",
            "city": "FORT WAYNE",
            "state": "IN",
            "postal_code": "468046894",
            "telephone_number": "260-486-5251",
            "fax_number": "260-486-5058"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4109 W JEFFERSON BLVD",
            "address_2": "STE A",
            "city": "FORT WAYNE",
            "state": "IN",
            "postal_code": "468046894",
            "telephone_number": "260-486-5251",
            "fax_number": "260-486-5058"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WALKER",
        "first_name": "ANGELA",
        "name_prefix": "Ms.",
        "credential": "LSCW, LCAC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2017-01-05",
        "last_updated": "2024-04-03",
        "certification_date": "2021-05-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "IN",
            "license": "87001240A",
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "IN",
            "license": "34007712A",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Fort Wayne, IN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 3, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.