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NPI Code Detail

MEDICARE: ANGELICA CANNON

MEDICARE: ANGELICA CANNON
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1101Y00000XCounselor

General Provider Information

NPI Number : 1649954009
Entity Type Code : Individual
Provider Name (Legal Business Name) : ANGELICA CANNON
Provider Business Mailing Address
First Line : 1106 CHIVALRY ST
Second Line :
City : SUMTER
State : SC
Zip : 29154-7412
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 755 ELECTRIC DR
Second Line :
City : SUMTER
State : SC
Zip : 29153-1933
Country : US
Telephone Number : 803-905-5100
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/14/2023
Last Update Date : 06/14/2023

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Directions to “ ANGELICA CANNON ” Practice Location

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