Provider Demographics
NPI:1174615678
Name:CANNAN, ASHLEY ALVARADO (MA, LPC, RPT)
Entity type:Individual
Prefix:MRS
First Name:ASHLEY
Middle Name:ALVARADO
Last Name:CANNAN
Suffix:
Gender:F
Credentials:MA, LPC, RPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:889 COMMONWEALTH AVE SE
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30312-3663
Mailing Address - Country:US
Mailing Address - Phone:404-354-7786
Mailing Address - Fax:775-313-0859
Practice Address - Street 1:464 CHEROKEE AVE SE
Practice Address - Street 2:SUITE 202
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30312-3260
Practice Address - Country:US
Practice Address - Phone:404-354-7786
Practice Address - Fax:775-313-0859
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-29
Last Update Date:2008-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37PC00341800101YP2500X
GALPC005408101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA309121396AMedicaid