Provider Demographics
NPI:1710879036
Name:CARMODY, CASSANDRA JO (ALC)
Entity type:Individual
Prefix:
First Name:CASSANDRA
Middle Name:JO
Last Name:CARMODY
Suffix:
Gender:F
Credentials:ALC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1003 WINCHESTER CIR
Mailing Address - Street 2:
Mailing Address - City:DOTHAN
Mailing Address - State:AL
Mailing Address - Zip Code:36303-1615
Mailing Address - Country:US
Mailing Address - Phone:319-640-5435
Mailing Address - Fax:
Practice Address - Street 1:3123 WESLEY WAY STE 2
Practice Address - Street 2:
Practice Address - City:DOTHAN
Practice Address - State:AL
Practice Address - Zip Code:36305-2020
Practice Address - Country:US
Practice Address - Phone:334-246-1270
Practice Address - Fax:334-246-1270
Is Sole Proprietor?:Yes
Enumeration Date:2025-07-21
Last Update Date:2025-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health