Healthcare Provider Details

I. General information

NPI: 1275463622
Provider Name (Legal Business Name): ANGELISHEA FERRELL
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/19/2026
Last Update Date: 05/19/2026
Certification Date: 05/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6169 SOUTHLAND TRCE
STONE MOUNTAIN GA
30087-4975
US

IV. Provider business mailing address

6169 SOUTHLAND TRCE
STONE MOUNTAIN GA
30087-4975
US

V. Phone/Fax

Practice location:
  • Phone: 470-642-9830
  • Fax:
Mailing address:
  • Phone: 470-642-9830
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number0904018468
License Number StateVA
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberCSW008751
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: