MS. BRENDA GAIL CANNON


Address: 3105 Vico Ter, Raleigh, NC 27610-5951
Phone: 9196378831

MS. BRENDA GAIL CANNON (NPI# 1114490877) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).

Provider Overview

Nation Provider ID (NPI) 1114490877
Entity Type Individual
Full Name MS. BRENDA GAIL CANNON
Credential BA IN PSYCHOLOGY
Practice Address 3105 Vico Ter
Raleigh
NC 27610-5951
Mailing Address 1301 Southgate Dr
Raleigh
NC 27610-5090
Practice Telephone 9196378831
Practice Fax Number 9198905578
Mailing Telephone 9196378831
Enumeration Date 2019-01-05
Last Update Date 2019-01-05
Gender Code F
Is Sole Proprietor Y

Taxonomy

Primary Taxonomy Code Classification License Number License State Taxonomy Group
Y 320600000X Residential Treatment Facility, Mental Retardation and/or Developmental Disabilities MHL-092-898 NC Residential Treatment Facilities
N 320600000X Residential Treatment Facility, Mental Retardation and/or Developmental Disabilities NC Residential Treatment Facilities

Other Providers BRENDA CANNON

NPI Name Taxonomy Address Enumeration
1962638908 Brenda Jean Cannon Counselor 1317 Boswell Dr, Laramie, WY 82070-5453 2009-06-04

Office Location

Street Address 3105 VICO TER
City RALEIGH
State NC
Zip Code 27610-5951

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1639646367 Carol Mary Medins Dietitian, Registered Wakemed Raleigh Medical Park, 23 Sunnybrook Road, Suite 200, Raleigh, NC 27610 2018-10-31
1144714601 Walgreen Co Durable Medical Equipment & Medical Supplies 123 Sunnybrook Rd Ste 150, Raleigh, NC 27610 2018-06-19
1417446006 Eagles Eye Lab, Inc Clinical Medical Laboratory 4501 New Bern Ave, Ste: 130, Raleigh, NC 27610 2018-05-09
1316465206 Jeffery King Neer Social Worker 3010 Falstaff Rd., C/o Unc Actt, Raleigh, NC 27610 2017-08-31
1083139885 Kelsey Daniel Mccleave Social Worker 3630 Enduring Freedom Drive, Raleigh, NC 27610 2017-08-14
1891219093 Tarheel Residential Services Community Based Residential Treatment, Mental Retardation and/or Developmental Disabilities 4840 Quarryman Road, Raleigh, NC 27610 2017-07-29
1508214826 Compassionate Care Providers LLC Respite Care 5110 Wetlands, Raleigh, NC 27610 2016-05-26
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Taxonomy Information

Taxonomy Code 320600000X
Grouping Residential Treatment Facilities
Classification Residential Treatment Facility, Mental Retardation and/or Developmental Disabilities

Taxonomy Definition

A residential facility that provides habilitation services and other care and treatment to adults or children diagnosed with developmental disabilities and/or mental retardation and are not able to live independently.
Notes: [7/1/2003: new]

Providers in the same taxonomy and city

NPI Name Taxonomy Address Enumeration
1144648452 Tlc Operations, Inc. Residential Treatment Facility, Mental Retardation and/or Developmental Disabilities 743 Chappell Drive, Raleigh, NC 27606-3215 2014-04-03
1649694423 Miley Home Residential Treatment Facility, Mental Retardation and/or Developmental Disabilities 1813 Elkpark Drive, Raleigh, NC 27610 2014-02-13
1659708790 Dowtin's Therapeutic Home Residential Treatment Facility, Mental Retardation and/or Developmental Disabilities 3912 Willow Oak Rd, Raleigh, NC 27604-4725 2013-10-03
1821420829 Mailey Home Residential Treatment Facility, Mental Retardation and/or Developmental Disabilities 1813 Elkpark Dr, Raleigh, NC 27610-5897 2013-08-01
1982043576 Kersey Home Residential Treatment Facility, Mental Retardation and/or Developmental Disabilities 1208 Armstrong Circle, Raleigh, NC 27610 2013-06-18
1801235551 Mcclain Home Residential Treatment Facility, Mental Retardation and/or Developmental Disabilities 712 Cupola Dr, Raleigh, NC 27603-3440 2013-06-17
1700225539 Sykes Home 1 Residential Treatment Facility, Mental Retardation and/or Developmental Disabilities 2532 Birchford Court, Raleigh, NC 27604 2013-06-14
1285073023 Terry's Safe Haven Residential Treatment Facility, Mental Retardation and/or Developmental Disabilities 8112 Running Cedar Trail, Raleigh, NC 27615 2013-06-14
1720427529 Hamilton Home Residential Treatment Facility, Mental Retardation and/or Developmental Disabilities 4280 Saubranch Hill Street, Raleigh, NC 27616 2013-06-14
1497031207 Living With Autisum Residential Treatment Facility, Mental Retardation and/or Developmental Disabilities 2817 Tobermory Ln, Raleigh, NC 27606-4443 2011-10-25
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Competitor

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City RALEIGH
Zip Code 27610

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Dataset Information

Data Provider Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES)
Jurisdiction Medicare & Medicaid

This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.

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