Individual
CHRISTINA L CANNON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RADT
Contact information
Practice address
63311 JAMISON ST, BEND, OR 97703-8288
(541) 332-7500
(541) 322-7565
Mailing address
2577 NE COURTNEY DR, BEND, OR 97701-7752
(541) 332-7500
(541) 322-7565
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
R1353740719
CA
175T00000X
Peer Specialist
Primary
—
—
Other
Enumeration date
07/10/2019
Last updated
05/04/2022
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