Healthcare Provider Details

I. General information

NPI: 1326800905
Provider Name (Legal Business Name): ANGELA MARIE HARTLEY
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/29/2024
Last Update Date: 07/28/2026
Certification Date: 07/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

514 W MAPLE ST STE 1201
CUMMING GA
30040-2536
US

IV. Provider business mailing address

6225 SANTA FE TRL
CUMMING GA
30028-4916
US

V. Phone/Fax

Practice location:
  • Phone: 678-395-3905
  • Fax: 770-995-1959
Mailing address:
  • Phone: 470-202-8510
  • Fax: 770-995-1959

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberLPC016905
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: