Individual
MRS. CARRIE ELLA CANNON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
M.A.
Contact information
Practice address
1615 MARTIN LUTHER KING BLVD, MALVERN, AR 72104-2233
(501) 332-5236
Mailing address
571 SAGINAW EDDY RD, DONALDSON, AR 71941-8060
(501) 515-8656
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
3455-C
AR
Other
Enumeration date
09/04/2008
Last updated
09/30/2019
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