Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YP2500X | Professional Counselor | 78375 | TX |
N | 225C00000X | Rehabilitation Counselor | 00230818 | TX |
NPI | 1205355260 |
---|---|
Provider Name | Sophia Ayana Cannon |
First Address | Denton, TX 76205-7946 |
Second Address | Denton, TX 76205-7946 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 11/09/2017 |
Last Update Date | 03/06/2019 |