Individual
CAROL W. CANNON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LICSW
Contact information
Practice address
251 N BAYOU ST, MOBILE, AL 36603-5827
(251) 690-8158
Mailing address
251 N BAYOU ST, MOBILE, AL 36603-5827
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
1064C
AL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
275693
—
AL
05
—
276253
—
AL
05
—
276301
—
AL
Enumeration date
07/15/2021
Last updated
12/30/2021
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