person
Derrick Cannon I
Peer Specialist in San Bernardino, California
NPI 1063057149

Derrick Cannon I is a Peer Specialist based in San Bernardino, CA. Derrick Cannon I practices in San Bernardino, CA. The NPI Number for Derrick Cannon I is 1063057149 and holds a License No. (California).

The current practice location address for Derrick Cannon I is 820 E Gilbert St, San Bernardino, CA and can be reached out via phone at 909-388-5644.

Location: 820 E Gilbert St, San Bernardino, CA, 92408-1403
person
Provider Profile Details
NPI Number
1063057149
Provider Name
Derrick Cannon I
Credential
Provider Entity Type
Individual
Gender
Male
Address
820 E Gilbert St, San Bernardino, CA, 92408-1403
Phone Number
909-388-5644
Fax Number
Provider Enumeration Date
11/12/2019
Last Update Date
03/10/2024
institution
Provider Business Practice Location Address Details
Address
820 E Gilbert St
City
State
Zip
92415-1403
Phone Number
909-388-5644
Fax Number
person
Provider Business Mailing Address Details
Address
820 E Gilbert St
City
State
Zip
92415-1403
Phone Number
909-388-5644
Fax Number
person
Provider's Taxonomy Details 1
Type
Other Service Providers
Classification
Peer Specialist
Speciality
-
Taxonomy
License No.
()
Definition
Individuals certified to perform peer support services through a training process defined by a government agency, such as the Department of Veterans Affairs or a state mental health department/certification/licensing authority.
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