Provider Demographics
NPI:1205263993
Name:CANNON, BRANDY M (MMFT, LMFT/I)
Entity type:Individual
Prefix:MRS
First Name:BRANDY
Middle Name:M
Last Name:CANNON
Suffix:
Gender:F
Credentials:MMFT, LMFT/I
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:28 PARKWAY COMMONS WAY
Mailing Address - Street 2:
Mailing Address - City:GREER
Mailing Address - State:SC
Mailing Address - Zip Code:29650-5213
Mailing Address - Country:US
Mailing Address - Phone:864-205-9249
Mailing Address - Fax:864-879-4303
Practice Address - Street 1:28 PARKWAY COMMONS WAY
Practice Address - Street 2:
Practice Address - City:GREER
Practice Address - State:SC
Practice Address - Zip Code:29650-5213
Practice Address - Country:US
Practice Address - Phone:864-205-9249
Practice Address - Fax:864-879-4303
Is Sole Proprietor?:Yes
Enumeration Date:2013-09-26
Last Update Date:2013-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC5399106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist