Individual
MR. KING EDWARD CANNON JR.
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
7384 JOHN LEBLANC BLVD, SORRENTO, LA 70778-3231
(225) 310-2600
Mailing address
7384 JOHN LEBLANC BLVD, SORRENTO, LA 70778-3231
(225) 310-2600
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
175T00000X
LA
175T00000X
Peer Specialist
Primary
—
—
Other
Enumeration date
03/23/2023
Last updated
03/24/2023
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