Individual
DEBRA CANNON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1580 CHAPEL ST, NEW HAVEN, CT 06511-4205
(203) 908-8978
Mailing address
33 TIERNEY RD, HAMDEN, CT 06514-4206
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
001391
CT
Other
Enumeration date
12/29/2020
Last updated
12/29/2020
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