Provider Demographics
NPI:1295148476
Name:MASSIE, CLARENCE W JR (ICADC, CADC-II, PC)
Entity type:Individual
Prefix:
First Name:CLARENCE
Middle Name:W
Last Name:MASSIE
Suffix:JR
Gender:M
Credentials:ICADC, CADC-II, PC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1414 MORELAND AVE SE
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30316-3207
Mailing Address - Country:US
Mailing Address - Phone:404-627-1774
Mailing Address - Fax:404-627-1765
Practice Address - Street 1:1414 MORELAND AVE SE
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30316-3207
Practice Address - Country:US
Practice Address - Phone:404-627-1774
Practice Address - Fax:404-627-1765
Is Sole Proprietor?:No
Enumeration Date:2014-06-05
Last Update Date:2014-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)