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General NPI Number Information
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NPI Number | 1487618211
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Entity Type | Individual
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Provider Name | JOHN ROY CANNON LPCMH
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Gender | Male
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Dates
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Enumeration Date | 04/17/2006
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Last Update Date | 09/11/2025
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Provider Practice Location Address
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Address Line | 117 LARKSPUR RD
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City | NEWARK
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State | DE
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Zip | 19711-6863
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Country | US
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Telephone | 302-738-9963
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Fax | 302-995-2121
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Provider Business Mailing Address
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Address Line | 117 LARKSPUR RD
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City | NEWARK
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State | DE
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Zip | 19711-6863
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Country | US
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Telephone | 302-738-9963
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Fax | 302-995-2121
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | 112
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License Number State | DE
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Taxonomy #2
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 4331
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License Number State | DE
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Taxonomy #3
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | PC-0000008
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License Number State | DE
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