NPIMap

Misty Cannon, CDCA

Individual provider Active NPI Addiction (Substance Use Disorder) Counselor · Jackson, OH

NPI 1053933176 · NPPES record last updated Aug 9, 2023

Key facts

NPI
1053933176
Entity type
Individual (NPI type 1)
Primary specialty
Addiction (Substance Use Disorder) Counselor 101YA0400X
Practice address
84 E Mound St
Jackson, OH 45640-1226
Phone
(740) 577-8348
NPI assigned
May 12, 2020
Sex
Female
Sole proprietor
No

Organizations & group practices 2

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

Medicare participation

Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

Medicare enrollment (NPD)
No

Practice roles

OrganizationSpecialtyStatusNew patients
Warriors 4 Christ Recovery Ministries Case Manager/Care Coordinator Current
since Jul 19, 2020		 Accepting new patients
Warriors 4 Christ Recovery Ministries Addiction (Substance Use Disorder) Current
since May 1, 2020		 Accepting new patients

Locations

84 E Mound St
Jackson, OH 45640
Phone (740) 577-3834

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
Case Manager/Care Coordinator 171M00000X
Addiction (Substance Use Disorder) Counselor 101YA0400X Yes

Addresses

Primary practice location

84 E Mound St
Jackson, OH 45640-1226

Mailing address

2100 Big Rock Rd
Jackson, OH 45640-9406
Phone (740) 978-0755

Other names

  • Misty Doles Other name

Other providers in Jackson, OH

All providers in Jackson, OH · Addiction (Substance Use Disorder) Counselor in Ohio

Sources for this page

Verify at the official NPI Registry.