Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 101Y00000X | Counselor | ||
Y | 101YM0800X | Mental Health Counselor | ||
N | 101YP2500X | Professional Counselor | GA | |
N | 103K00000X | Behavior Analyst | ||
N | 103TA0400X | Addiction Psychologist (Substance Use Disorder) | 2004 | GA |
NPI | 1356890107 |
---|---|
Provider Name | Mrs. Angela Murrah |
First Address | Jonesboro, GA 30236-4905 |
Second Address | Jonesboro, GA 30236-4905 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 21/09/2016 |
Last Update Date | 21/09/2016 |