Provider Demographics
NPI:1740824689
Name:POE, CECIL ANDREW
Entity type:Individual
Prefix:
First Name:CECIL
Middle Name:ANDREW
Last Name:POE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5609 FOX DEN TRL
Mailing Address - Street 2:
Mailing Address - City:LITHONIA
Mailing Address - State:GA
Mailing Address - Zip Code:30038-1602
Mailing Address - Country:US
Mailing Address - Phone:404-436-4597
Mailing Address - Fax:
Practice Address - Street 1:5609 FOX DEN TRL
Practice Address - Street 2:
Practice Address - City:LITHONIA
Practice Address - State:GA
Practice Address - Zip Code:30038-1602
Practice Address - Country:US
Practice Address - Phone:404-436-4597
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-11-04
Last Update Date:2019-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA10198608101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health