Healthcare Provider Details

I. General information

NPI: 1730900366
Provider Name (Legal Business Name): CASSIA ENCINIAS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/17/2024
Last Update Date: 10/17/2024
Certification Date: 10/17/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4720 PEACHTREE INDUSTRIAL BLVD STE 4101
BERKELEY LAKE GA
30071-5737
US

IV. Provider business mailing address

222 ROBIN LN
STOCKBRIDGE GA
30281-1790
US

V. Phone/Fax

Practice location:
  • Phone: 470-659-0171
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberAPC009765
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: