Provider Demographics
NPI:1679778757
Name:CANAFF, AUDREY LEA (PHD,LPC,MHSP)
Entity type:Individual
Prefix:DR
First Name:AUDREY
Middle Name:LEA
Last Name:CANAFF
Suffix:
Gender:F
Credentials:PHD,LPC,MHSP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1711 WILLIAMS ST
Mailing Address - Street 2:
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37408-1725
Mailing Address - Country:US
Mailing Address - Phone:423-267-4798
Mailing Address - Fax:423-267-4798
Practice Address - Street 1:1711 WILLIAMS ST
Practice Address - Street 2:
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37408-1725
Practice Address - Country:US
Practice Address - Phone:423-267-4798
Practice Address - Fax:423-267-4798
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN0000001501101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN4066220OtherBLUE CROSS BLUE SHIELS