Provider Demographics
NPI:1265104491
Name:CANNON, DAISHA RENEE (LMHCA)
Entity type:Individual
Prefix:MRS
First Name:DAISHA
Middle Name:RENEE
Last Name:CANNON
Suffix:
Gender:F
Credentials:LMHCA
Other - Prefix:MS
Other - First Name:DAISHA
Other - Middle Name:RENEE
Other - Last Name:ROBERTS-KIRBY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:12124 SE 292ND ST
Mailing Address - Street 2:
Mailing Address - City:AUBURN
Mailing Address - State:WA
Mailing Address - Zip Code:98092-2075
Mailing Address - Country:US
Mailing Address - Phone:253-266-0183
Mailing Address - Fax:
Practice Address - Street 1:312 11TH AVE W STE 201
Practice Address - Street 2:
Practice Address - City:KIRKLAND
Practice Address - State:WA
Practice Address - Zip Code:98033-5326
Practice Address - Country:US
Practice Address - Phone:425-576-1817
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-10-05
Last Update Date:2021-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMC61197776101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health