Provider Demographics
NPI:1114460243
Name:ANGELA RONAY RICHARDSON
Entity Type:Organization
Organization Name:ANGELA RONAY RICHARDSON
Other - Org Name:RECONNECT THERAPEUTIC ASSOCIATES, LLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO/THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:ANGELA
Authorized Official - Middle Name:R
Authorized Official - Last Name:RICHARDSON
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:678-424-8650
Mailing Address - Street 1:1264 CONCORD RD SE
Mailing Address - Street 2:SUITE 106
Mailing Address - City:SMYRNA
Mailing Address - State:GA
Mailing Address - Zip Code:30080-5302
Mailing Address - Country:US
Mailing Address - Phone:678-424-8650
Mailing Address - Fax:678-424-8652
Practice Address - Street 1:1264 CONCORD RD SE
Practice Address - Street 2:SUITE 106
Practice Address - City:SMYRNA
Practice Address - State:GA
Practice Address - Zip Code:30080-5302
Practice Address - Country:US
Practice Address - Phone:678-424-8650
Practice Address - Fax:678-424-8652
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-11-21
Last Update Date:2016-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPC007446101YM0800X, 101YP2500X, 102L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No102L00000XBehavioral Health & Social Service ProvidersPsychoanalystGroup - Multi-Specialty