Provider Demographics
NPI:1235570821
Name:CANADY, KATRINA M (NCC,LPC,CPCS,LCMHC-S)
Entity Type:Individual
Prefix:
First Name:KATRINA
Middle Name:M
Last Name:CANADY
Suffix:
Gender:F
Credentials:NCC,LPC,CPCS,LCMHC-S
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:288 GANDY CUT
Mailing Address - Street 2:
Mailing Address - City:RICHMOND HIL
Mailing Address - State:GA
Mailing Address - Zip Code:31324-2413
Mailing Address - Country:US
Mailing Address - Phone:910-728-5819
Mailing Address - Fax:
Practice Address - Street 1:288 GANDY CUT
Practice Address - Street 2:
Practice Address - City:RICHMOND HILL
Practice Address - State:GA
Practice Address - Zip Code:31324-3132
Practice Address - Country:US
Practice Address - Phone:915-213-4656
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-11
Last Update Date:2023-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCS8569101YP2500X
SCTLC263PC101YP2500X
FLTMPC2654101YP2500X
TX74961101YP2500X
101YP2500X
GA012345101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional