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).
| 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 |
| 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 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1962638908 | Brenda Jean Cannon | Counselor | 1317 Boswell Dr, Laramie, WY 82070-5453 | 2009-06-04 |
| Street Address |
3105 VICO TER |
| City | RALEIGH |
| State | NC |
| Zip Code | 27610-5951 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1609499243 | Elizabeth Ranganai Mavindidze | Social Worker | Wakemed Health and Hospitals, 3000 New Bern Avenue, Raleigh, NC 27610 | 2020-05-18 |
| 1851958839 | Alex & Associates, P.C. | Dentist | 1600 Cross Link Road, Unit 103, Raleigh, NC 27610 | 2019-05-24 |
| 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 |
| 1730552530 | Matthew Belair | Pharmacist | 1601-51 Cross Link Rd, Raleigh, NC 27610 | 2015-11-03 |
| Find all providers in zip 27610 | ||||
| Taxonomy Code | 320600000X |
| Grouping | Residential Treatment Facilities |
| Classification | Residential Treatment Facility, Mental Retardation and/or Developmental Disabilities |
| 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] |
| 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 |
| Find all providers in RALEIGH | ||||
Please comment or provide details below to improve the information on MS. BRENDA GAIL CANNON.
| 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.