Provider Demographics
NPI:1659064558
Name:KANSO, SAMMY (MS, LAPC, NCC)
Entity type:Individual
Prefix:
First Name:SAMMY
Middle Name:
Last Name:KANSO
Suffix:
Gender:M
Credentials:MS, LAPC, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2440 SANDY PLAINS ROAD
Mailing Address - Street 2:BUILDING 21, SUITE 200
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30066
Mailing Address - Country:US
Mailing Address - Phone:404-913-1615
Mailing Address - Fax:
Practice Address - Street 1:2440 SANDY PLAINS ROAD BUILDING 21, SUITE 200
Practice Address - Street 2:
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30066-5077
Practice Address - Country:US
Practice Address - Phone:770-993-9700
Practice Address - Fax:770-993-9800
Is Sole Proprietor?:No
Enumeration Date:2023-05-29
Last Update Date:2024-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAAPC009381101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health