Provider Demographics
NPI:1790151058
Name:BOOTHE, CASSANDRA M (LMFT)
Entity Type:Individual
Prefix:
First Name:CASSANDRA
Middle Name:M
Last Name:BOOTHE
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:CASSANDRA
Other - Middle Name:M
Other - Last Name:WRIGHT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMFT
Mailing Address - Street 1:4132 ATLANTA HWY STE 110-225
Mailing Address - Street 2:
Mailing Address - City:LOGANVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30052-5285
Mailing Address - Country:US
Mailing Address - Phone:678-806-6272
Mailing Address - Fax:
Practice Address - Street 1:4132 ATLANTA HWY STE 110-225
Practice Address - Street 2:
Practice Address - City:LOGANVILLE
Practice Address - State:GA
Practice Address - Zip Code:30052-5285
Practice Address - Country:US
Practice Address - Phone:678-806-6272
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-08-20
Last Update Date:2021-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAMFT001421106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist