Provider Demographics
NPI:1912640962
Name:ROYAL, CASSANDRA MONE (MA)
Entity Type:Individual
Prefix:MRS
First Name:CASSANDRA
Middle Name:MONE
Last Name:ROYAL
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5020 EAGLE CREEK DR
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28269-1519
Mailing Address - Country:US
Mailing Address - Phone:704-773-4905
Mailing Address - Fax:
Practice Address - Street 1:1400 BUFORD HWY STE C1
Practice Address - Street 2:
Practice Address - City:BUFORD
Practice Address - State:GA
Practice Address - Zip Code:30518-8722
Practice Address - Country:US
Practice Address - Phone:704-773-4905
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-04-18
Last Update Date:2022-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health