Brenda Gail Cannon, BA IN PSYCHOLOGY

Primary specialty

Intellectual and/or Developmental Disabilities Residential Treatment FacilityTaxonomy code 320600000X

License

MHL-092-898 Issued in NC

Practice address

3105 Vico Ter
Raleigh, NC 27610-5951

Phone

(919) 637-8831

Fax

(919) 890-5578

NPI assigned

Jan 5, 2019

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Bachelor of Arts

State licenses

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

{
    "created_epoch": "1546646400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1546646400000",
    "number": "1114490877",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1301 SOUTHGATE DR",
            "city": "RALEIGH",
            "state": "NC",
            "postal_code": "276105090",
            "telephone_number": "919-637-8831"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3105 VICO TER",
            "city": "RALEIGH",
            "state": "NC",
            "postal_code": "276105951",
            "telephone_number": "919-637-8831",
            "fax_number": "919-890-5578"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CANNON",
        "first_name": "BRENDA",
        "middle_name": "GAIL",
        "name_prefix": "Ms.",
        "credential": "BA IN PSYCHOLOGY",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2019-01-05",
        "last_updated": "2019-01-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "320600000X",
            "taxonomy_group": "",
            "desc": "Residential Treatment Facility, Intellectual and/or Developmental Disabilities",
            "state": "NC",
            "license": null,
            "primary": false
        },
        {
            "code": "320600000X",
            "taxonomy_group": "",
            "desc": "Residential Treatment Facility, Intellectual and/or Developmental Disabilities",
            "state": "NC",
            "license": "MHL-092-898",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Aja Mae Cann, LCSW
• Ora Nicole Cannady, M.ED CCC-SLP
• Megan Kathleen Cannan, AGACNP-BC
• Cannenta Wellness & Counseling Inc
• Katie D Cannizzaro, PT
• Gregory J Cannon, MD
• Ja'Kyra Tannell Cannon, PTA
• Jacqueline Felicia Cannon, APRN, AGPCNP
• Katherine Clifton Cannon, RD
• Nathalia Kalena Cannon, MS

• Intellectual and/or Developmental Disabilities Residential Treatment Facility in Raleigh, NC
• Providers in Raleigh, NC by specialty
• Intellectual and/or Developmental Disabilities Residential Treatment Facility in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 5, 2019; 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.