Provider Demographics
NPI:1760595607
Name:MCCANNA, NORA LEE (BSSW)
Entity Type:Individual
Prefix:MS
First Name:NORA
Middle Name:LEE
Last Name:MCCANNA
Suffix:
Gender:F
Credentials:BSSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4252 NORTH RIVER ROAD
Mailing Address - Street 2:
Mailing Address - City:FORT GRATIOT
Mailing Address - State:MI
Mailing Address - Zip Code:48059
Mailing Address - Country:US
Mailing Address - Phone:810-985-5822
Mailing Address - Fax:
Practice Address - Street 1:515 S PARKER ST
Practice Address - Street 2:SUITE D
Practice Address - City:MARINE CITY
Practice Address - State:MI
Practice Address - Zip Code:48039-3572
Practice Address - Country:US
Practice Address - Phone:810-765-5010
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIL881697104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker