Individual
MS. BRENDA GAIL CANNON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
BA IN PSYCHOLOGY
Contact information
Practice address
3105 VICO TER, RALEIGH, NC 27610-5951
(919) 637-8831
(919) 890-5578
Mailing address
1301 SOUTHGATE DR, RALEIGH, NC 27610-5090
(919) 637-8831
Taxonomy
Speciality
Code
Description
License number
State
320600000X
Intellectual and/or Developmental Disabilities Residential Treatment Facility
Primary
MHL-092-898
NC
320600000X
Intellectual and/or Developmental Disabilities Residential Treatment Facility
—
NC
Other
Enumeration date
01/05/2019
Last updated
01/05/2019
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