Provider Demographics
NPI:1679446835
Name:GOLLADAY, ANGELA (ERYT200, YACEP)
Entity type:Individual
Prefix:
First Name:ANGELA
Middle Name:
Last Name:GOLLADAY
Suffix:
Gender:F
Credentials:ERYT200, YACEP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5935 CRESTMOOR DR SE
Mailing Address - Street 2:
Mailing Address - City:KENTWOOD
Mailing Address - State:MI
Mailing Address - Zip Code:49508-6511
Mailing Address - Country:US
Mailing Address - Phone:616-805-9195
Mailing Address - Fax:
Practice Address - Street 1:5935 CRESTMOOR DR SE
Practice Address - Street 2:
Practice Address - City:KENTWOOD
Practice Address - State:MI
Practice Address - Zip Code:49508-6511
Practice Address - Country:US
Practice Address - Phone:616-805-9195
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-09-24
Last Update Date:2025-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI175T00000X, 171400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171400000XOther Service ProvidersHealth & Wellness Coach
No175T00000XOther Service ProvidersPeer Specialist