Provider Demographics
NPI:1558784900
Name:MENDEZ, ANGELA MARIA (MS, LPC)
Entity Type:Individual
Prefix:
First Name:ANGELA
Middle Name:MARIA
Last Name:MENDEZ
Suffix:
Gender:F
Credentials:MS, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:840 KENNESAW AVE NW STE 8
Mailing Address - Street 2:
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30060-7928
Mailing Address - Country:US
Mailing Address - Phone:678-923-6922
Mailing Address - Fax:
Practice Address - Street 1:840 KENNESAW AVE NW STE 8
Practice Address - Street 2:
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30060-7928
Practice Address - Country:US
Practice Address - Phone:678-923-6922
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-01-21
Last Update Date:2019-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPC007630101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional