Provider Demographics
NPI:1629647318
Name:CANNENTA CENTER FOR HEALING AND EMPOWERMENT LLC
Entity Type:Organization
Organization Name:CANNENTA CENTER FOR HEALING AND EMPOWERMENT LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FOUNDER/CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:LETICIA
Authorized Official - Middle Name:L
Authorized Official - Last Name:CAVAZOS
Authorized Official - Suffix:
Authorized Official - Credentials:LMSW, LCDC
Authorized Official - Phone:214-267-8946
Mailing Address - Street 1:15851 DALLAS PKWY STE 600
Mailing Address - Street 2:
Mailing Address - City:ADDISON
Mailing Address - State:TX
Mailing Address - Zip Code:75001-6030
Mailing Address - Country:US
Mailing Address - Phone:214-267-9556
Mailing Address - Fax:833-457-1700
Practice Address - Street 1:15851 DALLAS PKWY
Practice Address - Street 2:
Practice Address - City:ADDISON
Practice Address - State:TX
Practice Address - Zip Code:75001-3369
Practice Address - Country:US
Practice Address - Phone:214-267-9556
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-06-17
Last Update Date:2023-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty