Provider Demographics
NPI:1306085253
Name:CANNADY, FULIVIA ELMA (MSCP,NCC,LPC)
Entity type:Individual
Prefix:MRS
First Name:FULIVIA
Middle Name:ELMA
Last Name:CANNADY
Suffix:
Gender:F
Credentials:MSCP,NCC,LPC
Other - Prefix:MISS
Other - First Name:FULIVIA
Other - Middle Name:ELMA
Other - Last Name:BANKS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSCP,NCC,LPC
Mailing Address - Street 1:113B WILLOW BROOK DR
Mailing Address - Street 2:
Mailing Address - City:CLINTON
Mailing Address - State:MS
Mailing Address - Zip Code:39056-5802
Mailing Address - Country:US
Mailing Address - Phone:601-832-8264
Mailing Address - Fax:
Practice Address - Street 1:113B WILLOW BROOK DR
Practice Address - Street 2:
Practice Address - City:CLINTON
Practice Address - State:MS
Practice Address - Zip Code:39056-5802
Practice Address - Country:US
Practice Address - Phone:601-832-8264
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-02-17
Last Update Date:2009-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS208894101Y00000X
MS1220101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional