Provider Demographics
NPI:1922296508
Name:CANNON, CONSTANCE ELENA (PHD)
Entity Type:Individual
Prefix:DR
First Name:CONSTANCE
Middle Name:ELENA
Last Name:CANNON
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8830 CAMERON CT
Mailing Address - Street 2:SUITE 403
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20910-4114
Mailing Address - Country:US
Mailing Address - Phone:301-343-8654
Mailing Address - Fax:301-220-2836
Practice Address - Street 1:8830 CAMERON CT
Practice Address - Street 2:SUITE 403
Practice Address - City:SILVER SPRING
Practice Address - State:MD
Practice Address - Zip Code:20910-4114
Practice Address - Country:US
Practice Address - Phone:301-343-8654
Practice Address - Fax:301-220-2836
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-09
Last Update Date:2007-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD4307103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling