Individual provider · NPI-1

Patrice Cannon, LCSW

Social Worker, Clinical · Lithonia, GA

NPI number1386931962
StatusActive
Last updated in NPPESJul 5, 2011

Details

NPI
1386931962
Entity type
Individual (NPI-1)
Name
Patrice Cannon
Credential
LCSW
Sex
Female
Sole proprietor
Yes
Enumeration date
Jul 5, 2011
Last updated
Jul 5, 2011

Taxonomy and licenses

Taxonomy codeDescriptionLicenseStatePrimary
1041C0700X Social Worker, ClinicalCSW001836GAYes

Practice location

5481 Tunbridge Wells Rd
Lithonia, GA 30058-5684

Phone 678-460-0345 · Fax 678-460-0350

Mailing address

5481 Tunbridge Wells Rd
Lithonia, GA 30058-5684

Phone 678-460-0345 · Fax 678-460-0350

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