Provider Demographics
NPI:1225320914
Name:RICHARDSON, ANGELA RONAY (APC)
Entity Type:Individual
Prefix:
First Name:ANGELA
Middle Name:RONAY
Last Name:RICHARDSON
Suffix:
Gender:F
Credentials:APC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2916 LAUREL LN
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30344-2312
Mailing Address - Country:US
Mailing Address - Phone:404-290-0019
Mailing Address - Fax:
Practice Address - Street 1:2916 LAUREL LN
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30344-2312
Practice Address - Country:US
Practice Address - Phone:404-290-0019
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-05-12
Last Update Date:2011-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA003010101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional