Provider Demographics
NPI:1174546485
Name:CANTWELL, JUDITH MILANO (MED,LPC,NCC,CEAP)
Entity type:Individual
Prefix:
First Name:JUDITH
Middle Name:MILANO
Last Name:CANTWELL
Suffix:
Gender:F
Credentials:MED,LPC,NCC,CEAP
Other - Prefix:
Other - First Name:JUDY
Other - Middle Name:
Other - Last Name:CANTWELL
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MED,LPC,NCC,CEAP
Mailing Address - Street 1:1790 CENTURY BLVD NE
Mailing Address - Street 2:SUITE B
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30345-3322
Mailing Address - Country:US
Mailing Address - Phone:404-315-7331
Mailing Address - Fax:404-634-7090
Practice Address - Street 1:1790 CENTURY BLVD NE
Practice Address - Street 2:SUITE B
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30345-3322
Practice Address - Country:US
Practice Address - Phone:404-315-7331
Practice Address - Fax:404-634-7090
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPC001157101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional