Healthcare Provider Details

I. General information

NPI: 1972390896
Provider Name (Legal Business Name): GINGER MOORE CANNON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/23/2025
Last Update Date: 04/23/2025
Certification Date: 04/23/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

424 ESTHER CT
FORT MILL SC
29708-5707
US

IV. Provider business mailing address

438 GUILFORD RD
ROCK HILL SC
29732-1940
US

V. Phone/Fax

Practice location:
  • Phone: 201-906-1025
  • Fax:
Mailing address:
  • Phone: 843-312-0670
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number9048
License Number StateSC
# 2
Primary TaxonomyN
Taxonomy Code101YS0200X
TaxonomySchool Counselor
License Number244053
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: