Organization
CANNON PSYCHOLOGICAL ASSOCIATES, PC
Active
Organization
CANNON PSYCHOLOGICAL ASSOCIATES, PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. ELIZABETH TRACY GOODE (OFFICE MANAGER)
(864) 654-7848
Entity
Organization
Contact information
Practice address
1376 TIGER BLVD STE 210, CLEMSON, SC 29631-2654
(864) 654-7848
(864) 654-5777
Mailing address
1376 TIGER BLVD STE 210, CLEMSON, SC 29631-2654
(864) 654-7848
(864) 654-5777
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
349
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
PS0078
—
SC
Enumeration date
10/25/2006
Last updated
09/06/2023
Update your record
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