Provider Demographics
NPI:1649893314
Name:CANNON, TANDY ISRAEL (LCMHC)
Entity type:Individual
Prefix:
First Name:TANDY
Middle Name:ISRAEL
Last Name:CANNON
Suffix:
Gender:F
Credentials:LCMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:672 BATTLE CREEK RD
Mailing Address - Street 2:
Mailing Address - City:HORSE SHOE
Mailing Address - State:NC
Mailing Address - Zip Code:28742-4724
Mailing Address - Country:US
Mailing Address - Phone:719-214-8075
Mailing Address - Fax:
Practice Address - Street 1:1365 7TH AVE E
Practice Address - Street 2:
Practice Address - City:HENDERSONVILLE
Practice Address - State:NC
Practice Address - Zip Code:28792-2804
Practice Address - Country:US
Practice Address - Phone:828-702-7510
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-05-28
Last Update Date:2024-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC12622101YP2500X, 101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional