Provider Demographics
NPI:1255870424
Name:CANNON, JULIE ELIZABETH (LPC)
Entity Type:Individual
Prefix:MS
First Name:JULIE
Middle Name:ELIZABETH
Last Name:CANNON
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3991 GLADNEY DR
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30340-4617
Mailing Address - Country:US
Mailing Address - Phone:404-664-4581
Mailing Address - Fax:
Practice Address - Street 1:2849B HENDERSON MILL RD
Practice Address - Street 2:THE SAGE CENTER
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30341-5772
Practice Address - Country:US
Practice Address - Phone:404-664-4581
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-02-21
Last Update Date:2017-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPC003871101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional