Individual
CASSANDRA CONTON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LPC
Contact information
Practice address
1803 OVER LAKE DR SE, SUITE C, CONYERS, GA 30013-1789
(770) 679-4043
(770) 679-4915
Mailing address
1803 OVER LAKE DR SE, SUITE C, CONYERS, GA 30013-1789
(770) 679-4043
(770) 679-4915
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
Primary
LPC004669
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
159828861A
—
GA
01
—
202G708017
MEDICARE-GROUP PTAN
GA
01
—
202I688017
MEDICARE- PTAN
GA
Enumeration date
12/09/2008
Last updated
06/22/2012
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