| Doctor Name: | ANGELA R BLACK CHILDERS |
| NPI Number: | 1023368941 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | L.C.S.W. |
| License Number: | 149007668 |
| Business Practice Address: | 600 Spring Hill Ring Rd Suite 113 A West Dundee, IL - 601187300 |
| Business Phone Number: | 8156001999 |
| Business Fax Number: | |
| Mailing Address: | 307 Warner St, HAMPSHIRE |
| State: | IL |
| Postal Code: | 601409461 |
| Phone Number: | 8156001999 |
| Fax Number: | |
| NPI Enumeration Date: | 09/18/2012 |
| NPI Last Update Date: | 09/18/2012 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 1041C0700X |
| License Number: | 149007668 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | IL |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Social Worker |
| Taxonomy Specialization: | Clinical |
| Taxonomy Definition: | A social worker who holds a master |