Basic Information
Provider Information
NPI: 1831386184
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: CANNADY
FirstName: KAY
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential: LPC
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 2868 ACTON ROAD
Address2:  
City: BIRMINGHAM
State: AL
PostalCode: 35243
CountryCode: US
TelephoneNumber: 2059688360
FaxNumber: 2059688361
Practice Location
Address1: 5906 CARMICHAEL PLACE
Address2:  
City: MONTGOMERY
State: AL
PostalCode: 36117
CountryCode: US
TelephoneNumber: 3344099090
FaxNumber: 3344099669
Other Information
ProviderEnumerationDate: 10/01/2007
LastUpdateDate: 10/01/2007
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
101YM0800X1212ALY Behavioral Health & Social Service ProvidersCounselorMental Health

No ID Information.


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