Provider Demographics
NPI:1376266379
Name:MCCANNON, STEPHANIE C (HEALTH COACH)
Entity Type:Individual
Prefix:MS
First Name:STEPHANIE
Middle Name:C
Last Name:MCCANNON
Suffix:
Gender:F
Credentials:HEALTH COACH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5218 DOWNING RD
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21212-4114
Mailing Address - Country:US
Mailing Address - Phone:240-498-1120
Mailing Address - Fax:
Practice Address - Street 1:5218 DOWNING RD
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21212-4114
Practice Address - Country:US
Practice Address - Phone:240-498-1120
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-09-23
Last Update Date:2022-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD159327171400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171400000XOther Service ProvidersHealth & Wellness CoachGroup - Single Specialty