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General NPI Number Information
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NPI Number | 1184303372
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Entity Type | Individual
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Provider Name | ANGELIA PORTIA NALLS M DIV, MFT
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Gender | Female
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Dates
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Enumeration Date | 07/14/2023
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Last Update Date | 07/14/2023
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Provider Practice Location Address
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Address Line | 3940 SOMERLED TRL
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City | ATLANTA
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State | GA
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Zip | 30349-2036
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Country | US
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Telephone | 404-218-8524
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 951
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City | RED OAK
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State | GA
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Zip | 30272-0951
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Country | US
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Telephone | 404-218-8524
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Fax |
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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 | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | AMFT000713
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License Number State | GA
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