Basic Information
| Provider Information | |||||||||
| NPI: | 1053799445 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SUMRALL | ||||||||
| FirstName: | ANGELA | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | |||||||||
| NameSuffix: | |||||||||
| Credential: | MA, LPC | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | LINDROOS | ||||||||
| OtherFirstName: | ANGELA | ||||||||
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| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 1355 TERRELL MILL RD SE | ||||||||
| Address2: | BUILDING 1460, SUITE 205 | ||||||||
| City: | MARIETTA | ||||||||
| State: | GA | ||||||||
| PostalCode: | 300675496 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4044399981 | ||||||||
| FaxNumber: | 6782145591 | ||||||||
| Practice Location | |||||||||
| Address1: | 1355 TERRELL MILL RD SE | ||||||||
| Address2: | BUILDING 1460, SUITE 205 | ||||||||
| City: | MARIETTA | ||||||||
| State: | GA | ||||||||
| PostalCode: | 300675496 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4044399981 | ||||||||
| FaxNumber: | 6782145591 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/18/2015 | ||||||||
| LastUpdateDate: | 05/18/2015 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YP2500X | LPC008235 | GA | Y | Behavioral Health & Social Service Providers | Counselor | Professional |
No ID Information.