Provider Demographics
NPI:1235698457
Name:GEORGE CANNON, NICHOLE R (LPCC)
Entity Type:Individual
Prefix:
First Name:NICHOLE
Middle Name:R
Last Name:GEORGE CANNON
Suffix:
Gender:F
Credentials:LPCC
Other - Prefix:
Other - First Name:NICHOLE
Other - Middle Name:
Other - Last Name:GEORGE-DRIPPS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CDCA, LPC
Mailing Address - Street 1:3645 STUTZ DR STE A
Mailing Address - Street 2:
Mailing Address - City:CANFIELD
Mailing Address - State:OH
Mailing Address - Zip Code:44406-9168
Mailing Address - Country:US
Mailing Address - Phone:330-967-4111
Mailing Address - Fax:
Practice Address - Street 1:3645 STUTZ DR STE A
Practice Address - Street 2:
Practice Address - City:CANFIELD
Practice Address - State:OH
Practice Address - Zip Code:44406-9168
Practice Address - Country:US
Practice Address - Phone:330-967-4111
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-03-18
Last Update Date:2023-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHCDCA.168825101YA0400X
OHC.2103080101YP2500X, 101YP2500X
OHE.2303342101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)