Provider Demographics
NPI:1457732018
Name:FLEENOR, CATHY (BS,MA,BCCC,BCPC)
Entity Type:Individual
Prefix:MRS
First Name:CATHY
Middle Name:
Last Name:FLEENOR
Suffix:
Gender:F
Credentials:BS,MA,BCCC,BCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2550 HAMILTON MILL RD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:BUFORD
Mailing Address - State:GA
Mailing Address - Zip Code:30519-3611
Mailing Address - Country:US
Mailing Address - Phone:678-577-9628
Mailing Address - Fax:678-802-3684
Practice Address - Street 1:2550 HAMILTON MILL RD
Practice Address - Street 2:SUITE 100
Practice Address - City:BUFORD
Practice Address - State:GA
Practice Address - Zip Code:30519-3611
Practice Address - Country:US
Practice Address - Phone:678-577-9628
Practice Address - Fax:678-802-3684
Is Sole Proprietor?:Yes
Enumeration Date:2015-06-09
Last Update Date:2015-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA03126310101Y00000X
GA04146310101YP1600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YP1600XBehavioral Health & Social Service ProvidersCounselorPastoral