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General NPI Number Information
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NPI Number | 1942651120
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Entity Type | Individual
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Provider Name | ANGELA DAWN TOLLEY PE
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Gender | Female
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Dates
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Enumeration Date | 06/28/2016
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Last Update Date | 09/13/2024
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Provider Practice Location Address
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Address Line | 508 PRINCETON RD SUITE 403
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City | JOHNSON CITY
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State | TN
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Zip | 37601-2060
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Country | US
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Telephone | 423-302-3480
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Fax |
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Provider Business Mailing Address
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Address Line | 1021 W OAKLAND AVE STE 310
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City | JOHNSON CITY
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State | TN
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Zip | 37604-2192
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Country | US
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Telephone | 423-302-6565
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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 | 103T00000X
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Taxonomy Name | Psychologist
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License Number | 11116
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License Number State | TN
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Taxonomy #2
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 11116
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License Number State | TN
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