Cassandra Defeo, RD
Individual provider Active NPI Professional Counselor · Jekyll Island, GA
NPI 1013525401 · NPPES record last updated Aug 7, 2025
Key facts
- NPI
- 1013525401
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Professional Counselor 101YP2500X
- License
- LPC007019 (GA)
- Practice address
- 3 Forest Ave Apt a
Jekyll Island, GA 31527-0786 - Phone
- (912) 515-5822
- NPI assigned
- Jul 21, 2020
- Sex
- Female
- Sole proprietor
- Yes
Organizations & group practices 1
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| LPC007019 | GA | MD | Professional Counselor |
| LD004284 | GA | MD | Registered Dietitian |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Nourished Roots Consulting, LLC | Dietitian, Registered | Current |
Accepting new patients |
Locations
1405 Newcastle St
Brunswick, GA 31520
Phone (912) 515-5822
406 Union St
St Simons Island, GA 31522
Phone (912) 242-2302
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Professional Counselor | 101YP2500X | LPC007019 | GA | Yes |
| Registered Dietitian | 133V00000X | LD004284 | GA |
Addresses
Primary practice location
3 Forest Ave Apt a
Jekyll Island, GA 31527-0786
Mailing address
3 Forest Ave Apt a
Jekyll Island, GA 31527-0786
Other providers in Jekyll Island, GA
- Gena Helen Connally
- Judy Genene Cox
- Frances Lee Duncan
- Franklin Davis Duncan
- Hamilton Waters, Inc
- Dustin Cole Horne
- Jekyll Island State Park Authority
All providers in Jekyll Island, GA · Professional Counselor in Georgia
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Aug 7, 2025. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.