Provider Demographics
NPI:1609290121
Name:CANNON, LUCY ROBERTS (LCSW)
Entity Type:Individual
Prefix:DR
First Name:LUCY
Middle Name:ROBERTS
Last Name:CANNON
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:DR
Other - First Name:LUCY
Other - Middle Name:MAE
Other - Last Name:ROBERTS-CANNON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LCSW
Mailing Address - Street 1:100 EDGEWOOD AVE NE
Mailing Address - Street 2:1800
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30303-3026
Mailing Address - Country:US
Mailing Address - Phone:404-875-0201
Mailing Address - Fax:800-661-2054
Practice Address - Street 1:100 EDGEWOOD AVE NE
Practice Address - Street 2:1800
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30303-3026
Practice Address - Country:US
Practice Address - Phone:404-875-0201
Practice Address - Fax:800-661-2054
Is Sole Proprietor?:No
Enumeration Date:2014-02-05
Last Update Date:2014-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACSW002455104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker