IndividualActive
Brenda Cannon, BA IN PSYCHOLOGY
NPI 1114490877 · Intellectual and/or Developmental Disabilities Residential Treatment Facility · Raleigh, NC
Provider details
- NPI number
- 1114490877
- Entity type
- Individual
- Primary specialty
- Intellectual and/or Developmental Disabilities Residential Treatment FacilityResidential Treatment Facilities
- Credential
- BA IN PSYCHOLOGY
- Sex
- Female
- Sole proprietor
- Yes
Specialties & taxonomies
- Intellectual and/or Developmental Disabilities Residential Treatment FacilityPrimary320600000XLicense MHL-092-898 (NC)
Residential Treatment Facilities
Residential Treatment Facilities
Practice location
3105 Vico Ter
Raleigh, NC 27610-5951
Phone: (919) 637-8831
Fax: (919) 890-5578
Approximate (ZIP-level) locationGet directions
Mailing address
1301 Southgate Dr
Raleigh, NC 27610-5090
Registry dates
- Enumerated
- 2019-01-05
- Last updated
- 2019-01-05
Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.