Individual
RENETTA DAWN CANNON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LSAA
Contact information
Practice address
600 1ST ST NW STE 200, ALBUQUERQUE, NM 87102-2311
(505) 224-9124
(505) 247-9503
Mailing address
600 1ST ST NW STE 200, ALBUQUERQUE, NM 87102-2311
(505) 224-9124
(505) 247-9503
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
0084181
NM
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
71750274
—
NM
Enumeration date
10/01/2009
Last updated
10/01/2009
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