Provider Demographics
NPI:1740241322
Name:CANNON, PAULA J (LCSW, ACSW)
Entity Type:Individual
Prefix:MRS
First Name:PAULA
Middle Name:J
Last Name:CANNON
Suffix:
Gender:F
Credentials:LCSW, ACSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:93 HANLON MOUNTAIN RD
Mailing Address - Street 2:
Mailing Address - City:LEICESTER
Mailing Address - State:NC
Mailing Address - Zip Code:28748-6301
Mailing Address - Country:US
Mailing Address - Phone:828-683-5923
Mailing Address - Fax:
Practice Address - Street 1:277 BILTMORE AVE
Practice Address - Street 2:
Practice Address - City:ASHEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28801-4157
Practice Address - Country:US
Practice Address - Phone:828-253-6306
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-03-31
Last Update Date:2012-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCC0052101041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6106384Medicaid
IA38971OtherWELLMARK
IA38971OtherWELLMARK
NC2876885Medicare PIN