Provider Demographics
NPI:1609367440
Name:LANDRY, ANEESAH (LPC, NCC)
Entity Type:Individual
Prefix:MRS
First Name:ANEESAH
Middle Name:
Last Name:LANDRY
Suffix:
Gender:F
Credentials:LPC, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8119 PLEASANT RIDGE DR
Mailing Address - Street 2:
Mailing Address - City:MIDLAND
Mailing Address - State:GA
Mailing Address - Zip Code:31820-4225
Mailing Address - Country:US
Mailing Address - Phone:706-662-3825
Mailing Address - Fax:706-327-5294
Practice Address - Street 1:8119 PLEASANT RIDGE DR
Practice Address - Street 2:
Practice Address - City:MIDLAND
Practice Address - State:GA
Practice Address - Zip Code:31820-4225
Practice Address - Country:US
Practice Address - Phone:706-662-3825
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-05-29
Last Update Date:2023-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPC013706101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty