Healthcare Provider Details

I. General information

NPI: 1073981239
Provider Name (Legal Business Name): CASSANDRA M. AVELLANEDA LMHC, LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/04/2015
Last Update Date: 12/20/2023
Certification Date: 12/20/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1102 WILLIAMS ST
VALDOSTA GA
31601-4041
US

IV. Provider business mailing address

1102 WILLIAMS ST
VALDOSTA GA
31601-4041
US

V. Phone/Fax

Practice location:
  • Phone: 229-588-2266
  • Fax: 229-506-6877
Mailing address:
  • Phone: 229-588-2266
  • Fax: 229-506-6877

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberIMH13849
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberLPC014215
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: