Provider Demographics
NPI:1558400879
Name:POOLE, ANGELA RENEE (LMFT)
Entity Type:Individual
Prefix:
First Name:ANGELA
Middle Name:RENEE
Last Name:POOLE
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:ANGELA
Other - Middle Name:RENEE
Other - Last Name:POOLE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CROSSON
Mailing Address - Street 1:6 HOLMES CT
Mailing Address - Street 2:
Mailing Address - City:POOLER
Mailing Address - State:GA
Mailing Address - Zip Code:31322-4800
Mailing Address - Country:US
Mailing Address - Phone:770-389-8100
Mailing Address - Fax:
Practice Address - Street 1:401 OLD KENNEDY LN
Practice Address - Street 2:
Practice Address - City:STATESBORO
Practice Address - State:GA
Practice Address - Zip Code:30458-7846
Practice Address - Country:US
Practice Address - Phone:478-420-2336
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-05
Last Update Date:2023-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAMFT001873106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist