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General NPI Number Information
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NPI Number | 1053799445
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Entity Type | Individual
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Provider Name | ANGELA SUMRALL MA, LPC
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Gender | Female
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Dates
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Enumeration Date | 05/18/2015
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Last Update Date | 05/18/2015
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Provider Practice Location Address
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Address Line | 1355 TERRELL MILL RD SE BUILDING 1460, SUITE 205
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City | MARIETTA
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State | GA
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Zip | 30067-5496
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Country | US
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Telephone | 404-439-9981
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Fax | 678-214-5591
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Provider Business Mailing Address
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Address Line | 1355 TERRELL MILL RD SE BUILDING 1460, SUITE 205
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City | MARIETTA
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State | GA
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Zip | 30067-5496
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Country | US
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Telephone | 404-439-9981
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Fax | 678-214-5591
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | LPC008235
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License Number State | GA
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