Provider Demographics
NPI:1851966253
Name:CANNICK, HARVIETTA ELAINE
Entity Type:Individual
Prefix:
First Name:HARVIETTA
Middle Name:ELAINE
Last Name:CANNICK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:980 WALTHER BLVD APT 724
Mailing Address - Street 2:
Mailing Address - City:LAWRENCEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30043-8426
Mailing Address - Country:US
Mailing Address - Phone:404-740-0481
Mailing Address - Fax:
Practice Address - Street 1:980 WALTHER BLVD APT 724
Practice Address - Street 2:
Practice Address - City:LAWRENCEVILLE
Practice Address - State:GA
Practice Address - Zip Code:30043-8426
Practice Address - Country:US
Practice Address - Phone:404-740-0481
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-05-26
Last Update Date:2021-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101Y00000XBehavioral Health & Social Service ProvidersCounselor