Provider Demographics
NPI:1265156103
Name:LABABIDI, DEANNA ALI
Entity type:Individual
Prefix:
First Name:DEANNA
Middle Name:ALI
Last Name:LABABIDI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:DEANNA
Other - Middle Name:LABABIDI
Other - Last Name:CASSELL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LAPC
Mailing Address - Street 1:2 COLLINS PL
Mailing Address - Street 2:
Mailing Address - City:CARTERSVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30121-2230
Mailing Address - Country:US
Mailing Address - Phone:770-880-6834
Mailing Address - Fax:
Practice Address - Street 1:1800 LAKE PARK DR SE STE 123
Practice Address - Street 2:
Practice Address - City:SMYRNA
Practice Address - State:GA
Practice Address - Zip Code:30080-7639
Practice Address - Country:US
Practice Address - Phone:404-905-1755
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-10-03
Last Update Date:2023-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101Y00000X, 101YM0800X
APC009166101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health