Provider Demographics
NPI:1770628299
Name:ROYAL, CASSANDRA JOANNE (MA, LPC, CPCS, CCM)
Entity Type:Individual
Prefix:MS
First Name:CASSANDRA
Middle Name:JOANNE
Last Name:ROYAL
Suffix:
Gender:F
Credentials:MA, LPC, CPCS, CCM
Other - Prefix:MS
Other - First Name:CASSANDRA
Other - Middle Name:JOANNE
Other - Last Name:KAESER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:35 CROSSBILL TRL
Mailing Address - Street 2:
Mailing Address - City:COVINGTON
Mailing Address - State:GA
Mailing Address - Zip Code:30014-7658
Mailing Address - Country:US
Mailing Address - Phone:678-532-7415
Mailing Address - Fax:
Practice Address - Street 1:2146 CLARK ST SW
Practice Address - Street 2:
Practice Address - City:COVINGTON
Practice Address - State:GA
Practice Address - Zip Code:30014-2231
Practice Address - Country:US
Practice Address - Phone:678-532-7415
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-21
Last Update Date:2021-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH021298101YA0400X
OH171M00000X
GALPC00931101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No171M00000XOther Service ProvidersCase Manager/Care Coordinator