Individual
ANGELA DUSTIN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MA
Contact information
Practice address
365 NORTHRIDGE RD STE 310, ATLANTA, GA 30350-6101
(770) 335-9749
Mailing address
714 PAINT HORSE DR, CANTON, GA 30115-6829
(801) 722-9795
Taxonomy
Speciality
Code
Description
License number
State
106H00000X
Marriage & Family Therapist
Primary
2944560
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
123456
NO INSURANCE ACCEPTED
—
Enumeration date
08/25/2021
Last updated
08/25/2021
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