Provider Demographics
NPI:1285735340
Name:LANDRY, CASSANDRA JOHNSON (LPC)
Entity type:Individual
Prefix:MS
First Name:CASSANDRA
Middle Name:JOHNSON
Last Name:LANDRY
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3524 HABERSHAM AT NORTHLAKE
Mailing Address - Street 2:BLDG. A
Mailing Address - City:TUCKER
Mailing Address - State:GA
Mailing Address - Zip Code:30084-4009
Mailing Address - Country:US
Mailing Address - Phone:678-406-9707
Mailing Address - Fax:678-406-9881
Practice Address - Street 1:3524 HABERSHAM AT NORTHLAKE
Practice Address - Street 2:BLDG. A
Practice Address - City:TUCKER
Practice Address - State:GA
Practice Address - Zip Code:30084-4009
Practice Address - Country:US
Practice Address - Phone:678-406-9707
Practice Address - Fax:678-406-9881
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-25
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPC4114101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional