Healthcare Provider Details

I. General information

NPI: 1437784501
Provider Name (Legal Business Name): ANGELA RENEE MCGAHA KERSEY MS, LPC, NCC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/09/2020
Last Update Date: 12/10/2025
Certification Date: 12/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4434 COLUMBIA RD STE 205
MARTINEZ GA
30907-4281
US

IV. Provider business mailing address

4434 COLUMBIA RD STE 205
MARTINEZ GA
30907-4281
US

V. Phone/Fax

Practice location:
  • Phone: 706-910-0538
  • Fax: 706-910-0537
Mailing address:
  • Phone: 706-910-0538
  • Fax: 706-910-0537

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLPC014789
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: