Provider Demographics
NPI:1346000551
Name:DENNISON, ANGEL (LMSW)
Entity Type:Individual
Prefix:
First Name:ANGEL
Middle Name:
Last Name:DENNISON
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2500 PLEASANT HILL RD APT 2526
Mailing Address - Street 2:
Mailing Address - City:DULUTH
Mailing Address - State:GA
Mailing Address - Zip Code:30096-4182
Mailing Address - Country:US
Mailing Address - Phone:470-509-0595
Mailing Address - Fax:
Practice Address - Street 1:925 WOODSTOCK RD STE 150
Practice Address - Street 2:
Practice Address - City:ROSWELL
Practice Address - State:GA
Practice Address - Zip Code:30075-2208
Practice Address - Country:US
Practice Address - Phone:404-990-4240
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-03-22
Last Update Date:2024-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAMSW009777104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker