Provider Demographics
NPI:1215371356
Name:KELLY, TANGALERIA JONES (LPC)
Entity Type:Individual
Prefix:
First Name:TANGALERIA
Middle Name:JONES
Last Name:KELLY
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:P.O.BOX 1383
Mailing Address - Street 2:
Mailing Address - City:RED OAK
Mailing Address - State:GA
Mailing Address - Zip Code:30272
Mailing Address - Country:US
Mailing Address - Phone:678-559-5768
Mailing Address - Fax:404-684-9601
Practice Address - Street 1:1882 PRINCETON AVE
Practice Address - Street 2:STE 9A
Practice Address - City:COLLEGE PARK
Practice Address - State:GA
Practice Address - Zip Code:30337-3537
Practice Address - Country:US
Practice Address - Phone:678-559-5768
Practice Address - Fax:404-684-9601
Is Sole Proprietor?:No
Enumeration Date:2013-04-19
Last Update Date:2013-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPC005838101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional