Individual
LAVERNE BERNETTE CANNON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LCASA
Contact information
Practice address
2152 FLAGSTONE CT APT M4, GREENVILLE, NC 27834-8794
(252) 902-7184
Mailing address
2152 M4 FLAGSTONE COURT, GREENVILLE, NC 27834
(252) 902-7184
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
3503A
NC
Other
Enumeration date
09/01/2016
Last updated
09/07/2016
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