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: 05/29/2026
Certification Date: 05/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

884 LEGACY PARK DR
LAWRENCEVILLE GA
30043-8757
US

IV. Provider business mailing address

884 LEGACY PARK DR
LAWRENCEVILLE GA
30043-8757
US

V. Phone/Fax

Practice location:
  • Phone: 770-626-5302
  • Fax:
Mailing address:
  • Phone: 770-626-5302
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberAPC009765
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: