Healthcare Provider Details

I. General information

NPI: 1881414134
Provider Name (Legal Business Name): ARIEANA GABRIELLE CANNON
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/11/2024
Last Update Date: 06/12/2026
Certification Date: 06/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9807 BRISTOL SQUARE LN APT 302
BETHESDA MD
20814-5464
US

IV. Provider business mailing address

712 W MEADECREST DR
KNOXVILLE TN
37923-2487
US

V. Phone/Fax

Practice location:
  • Phone: 865-549-0171
  • Fax:
Mailing address:
  • Phone: 865-549-0171
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106E00000X
TaxonomyAssistant Behavior Analyst
License Number0134000694
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: