Provider Demographics
NPI:1073981239
Name:AVELLANEDA, CASSANDRA M (LMHC, LPC)
Entity Type:Individual
Prefix:MS
First Name:CASSANDRA
Middle Name:M
Last Name:AVELLANEDA
Suffix:
Gender:F
Credentials:LMHC, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1102 WILLIAMS ST
Mailing Address - Street 2:
Mailing Address - City:VALDOSTA
Mailing Address - State:GA
Mailing Address - Zip Code:31601-4041
Mailing Address - Country:US
Mailing Address - Phone:229-588-2266
Mailing Address - Fax:229-506-6877
Practice Address - Street 1:1102 WILLIAMS ST
Practice Address - Street 2:
Practice Address - City:VALDOSTA
Practice Address - State:GA
Practice Address - Zip Code:31601-4041
Practice Address - Country:US
Practice Address - Phone:229-588-2266
Practice Address - Fax:229-506-6877
Is Sole Proprietor?:Yes
Enumeration Date:2015-09-04
Last Update Date:2023-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPC014215101YP2500X
FLIMH13849101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health