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Individual
JUSTIN DEANDRE CANNON
Active
Individual
JUSTIN DEANDRE CANNON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LCSW
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
104745
TX
1041C0700X
Clinical Social Worker
Primary
104745
TX
Other
Enumeration date
03/07/2022
Last updated
10/09/2024
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