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Ms. Brenda Gail Cannon, BAINPSYCHOLOGY
Intellectual and/or Developmental Disabilities Residential Treatment Facility in Raleigh, North Carolina
NPI 1114490877

Brenda Gail Cannon is a Intellectual and/or Developmental Disabilities Residential Treatment Facility based in Raleigh, NC. Brenda Gail Cannon practices in Raleigh, NC and has the professional credentials of BAINPSYCHOLOGY. The NPI Number for Brenda Gail Cannon is 1114490877 and holds a License No. (North Carolina).

The current practice location address for Brenda Gail Cannon is 3105 Vico Ter, Raleigh, NC and can be reached out via phone at 919-637-8831 and via fax at 919-890-5578.

Location: 3105 Vico Ter, Raleigh, NC, 27610-5090
Profile Details Legacy Identifiers Practice Address Mailing Address Primary Taxonomy
person
Provider Profile Details
NPI Number
1114490877
Provider Name
Brenda Gail Cannon
Credential
BAINPSYCHOLOGY
Provider Entity Type
Individual
Gender
Female
Address
3105 Vico Ter, Raleigh, NC, 27610-5090
Phone Number
919-637-8831
Fax Number
919-890-5578
Provider Enumeration Date
01/05/2019
Last Update Date
03/10/2024
institution
Provider Business Practice Location Address Details
Address
3105 Vico Ter
City
Raleigh
State
North Carolina
Zip
27610-5951
Phone Number
919-637-8831
Fax Number
919-890-5578
person
Provider Business Mailing Address Details
Address
3105 Vico Ter
City
Raleigh
State
North Carolina
Zip
27610-5951
Phone Number
919-637-8831
Fax Number
919-890-5578
person
Provider's Taxonomy Details 1
Type
Residential Treatment Facilities
Classification
Residential Treatment Facility, Intellectual and/or Developmental Disabilities
Speciality
-
Taxonomy
320600000X
License No.
(North Carolina)
Definition
A residential facility that provides habilitation services and other care and treatment to adults or children diagnosed with developmental and intellectual disabilities and are not able to live independently.
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