Provider Demographics
NPI:1629317615
Name:POWELL-SMITH, ANGELA (EDD, LPC,)
Entity Type:Individual
Prefix:MRS
First Name:ANGELA
Middle Name:
Last Name:POWELL-SMITH
Suffix:
Gender:F
Credentials:EDD, LPC,
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6725 BENTLEY RIDGE DR
Mailing Address - Street 2:
Mailing Address - City:CUMMING
Mailing Address - State:GA
Mailing Address - Zip Code:30040-5753
Mailing Address - Country:US
Mailing Address - Phone:404-219-6464
Mailing Address - Fax:470-253-8191
Practice Address - Street 1:175 GWINNETT DR
Practice Address - Street 2:
Practice Address - City:LAWRENCEVILLE
Practice Address - State:GA
Practice Address - Zip Code:30046-8444
Practice Address - Country:US
Practice Address - Phone:678-209-2394
Practice Address - Fax:678-212-6350
Is Sole Proprietor?:No
Enumeration Date:2013-02-11
Last Update Date:2014-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA3200101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional