Individual
CHARLES BRUCE CANNON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.ED., LPC
Contact information
Practice address
2715 COLONIAL DR, COLUMBIA, SC 29203-6818
(803) 898-8888
Mailing address
3004 EXMOOR RD, COLUMBIA, SC 29204-7712
(803) 787-5763
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
0271
SC
Other
Enumeration date
10/13/2006
Last updated
07/08/2007
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