Provider Demographics
NPI:1295126696
Name:MADRY, CALITA (LPC, CMFT, NCC)
Entity type:Individual
Prefix:
First Name:CALITA
Middle Name:
Last Name:MADRY
Suffix:
Gender:F
Credentials:LPC, CMFT, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:113 ANCIENT OAK LN
Mailing Address - Street 2:
Mailing Address - City:STOCKBRIDGE
Mailing Address - State:GA
Mailing Address - Zip Code:30281-6530
Mailing Address - Country:US
Mailing Address - Phone:678-964-5795
Mailing Address - Fax:
Practice Address - Street 1:205 CORPORATE CENTER DR STE E
Practice Address - Street 2:
Practice Address - City:STOCKBRIDGE
Practice Address - State:GA
Practice Address - Zip Code:30281-7383
Practice Address - Country:US
Practice Address - Phone:678-964-5795
Practice Address - Fax:678-759-8404
Is Sole Proprietor?:No
Enumeration Date:2015-02-07
Last Update Date:2024-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPC009446101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional