MEDICARE: MS. LYDIA J CANTY LPC, NCC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YP2500X	Professional Counselor	LPC004261	GA

General Provider Information

NPI Number	:	1457348260
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. LYDIA J CANTY LPC, NCC

Provider Business Mailing Address
First Line	:	3759 BIRCHBRIAR CT
Second Line	:
City	:	DECATUR
State	:	GA
Zip	:	30034-4539
Country	:	US
Telephone Number	:	404-284-4725
Fax Number	:

Provider Business Practice Location Address
First Line	:	1640 POWERS FERRY RD
Second Line	:	BLDG 9, SUITE100
City	:	MARIETTA
State	:	GA
Zip	:	30067-5491
Country	:	US
Telephone Number	:	770-953-0080
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/06/2005
Last Update Date	:	07/08/2007

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