Misty Cannon, CDCA

Primary specialty

Addiction (Substance Use Disorder) CounselorTaxonomy code 101YA0400X

Practice address

84 E Mound St
Jackson, OH 45640-1226

Phone

(740) 577-8348

NPI assigned

May 12, 2020

Last updated

Aug 9, 2023By the provider in NPPES

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Other names 1

• Misty Doles Other name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Warriors 4 Christ Recovery Ministries

  • Addiction (Substance Use Disorder) Counselor
  • Jackson, OH
  • NPI 1700413424
  NPD
• Warriors 4 Christ Recovery Ministries

  • Mental Health Counselor
  • Jackson, OH
  • NPI 1720606148

  Case Manager/Care Coordinator

  NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1589241600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1691539200000",
    "number": "1053933176",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2100 BIG ROCK RD",
            "city": "JACKSON",
            "state": "OH",
            "postal_code": "456409406",
            "telephone_number": "740-978-0755"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "84 E MOUND ST",
            "city": "JACKSON",
            "state": "OH",
            "postal_code": "456401226",
            "telephone_number": "740-577-8348"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CANNON",
        "first_name": "MISTY",
        "name_prefix": "Mrs.",
        "credential": "CDCA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2020-05-12",
        "last_updated": "2023-08-09",
        "certification_date": "2023-08-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "171M00000X",
            "taxonomy_group": "",
            "desc": "Case Manager/Care Coordinator",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "MISTY",
            "last_name": "DOLES",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

• Buckeye Forest at Jackson LLC
• Aasia Butt, M.D
• Craig Cales
• Dorian R Callahan, LPCC
• Melinda Cannon, FNP-C
• Thomas James Cannon, CDCA
• Angela Lynn Canode, REGISTERED NURSE
• Ashley D Carder, PA
• Abigail Shannon Carter
• Eric W Carter, CRNA

• Addiction (Substance Use Disorder) Counselor in Jackson, OH
• Providers in Jackson, OH by specialty
• Addiction (Substance Use Disorder) Counselor in Ohio

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 9, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.