Healthcare Provider Details

I. General information

NPI: 1972090538
Provider Name (Legal Business Name): KELLEY DYANNE SPROLES LMFT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/19/2018
Last Update Date: 10/30/2025
Certification Date: 10/30/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5480 MCGINNIS VILLAGE PL STE 104
ALPHARETTA GA
30005-1746
US

IV. Provider business mailing address

5480 MCGINNIS VILLAGE PL STE 104
ALPHARETTA GA
30005-1746
US

V. Phone/Fax

Practice location:
  • Phone: 678-213-2194
  • Fax: 678-922-7767
Mailing address:
  • Phone: 678-213-2194
  • Fax: 678-922-7767

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberMFT001763
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: