Angela Cannon, NCC
Counselor, Mental Health in Lithonia, GA. Individual provider (NPI-1).
NPI number1104288273
StatusActive
Last updated in NPPESMar 20, 2024
Details
- NPI
- 1104288273
- Entity type
- Individual (NPI-1)
- Name
- Angela Cannon
- Credential
- NCC
- Sex
- Female
- Sole proprietor
- No
- Enumeration date
- Mar 28, 2016
- Certification date
- Mar 19, 2024
- Last updated
- Mar 20, 2024
Medicare and OIG
- Medicare enrolled (PECOS)
- Not in the Medicare enrollment file
- Can order and refer
- Not on the CMS order and referring list
- OIG exclusion list
- This NPI is not listed
CMS and OIG files of November 2026. PECOS lookup · OIG exclusion check
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 101YM0800X | Counselor, Mental Health | – | – | Yes |
| 101YM0800X | Counselor, Mental Health | 010635 | GA |
Practice location
5811 Bellingrath WayLithonia, GA 30058-3209
Phone 404-788-9237
Mailing address
5811 Bellingrath WayLithonia, GA 30058-3209
Phone 404-788-9237
Is something wrong?
This page shows exactly what the provider filed with NPPES. Only the provider (or their surrogate) can change it, by signing in to NPPES. Our page updates within a day of their change. See how to update NPI information.
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