Provider Demographics
NPI:1952082596
Name:CANNON, ANDREA LEE POLLOCK (LCSW-A)
Entity Type:Individual
Prefix:
First Name:ANDREA
Middle Name:LEE POLLOCK
Last Name:CANNON
Suffix:
Gender:F
Credentials:LCSW-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:318 E MAIN ST # A
Mailing Address - Street 2:
Mailing Address - City:HAVELOCK
Mailing Address - State:NC
Mailing Address - Zip Code:28532-2214
Mailing Address - Country:US
Mailing Address - Phone:252-622-9818
Mailing Address - Fax:252-444-6800
Practice Address - Street 1:318 E MAIN ST # A
Practice Address - Street 2:
Practice Address - City:HAVELOCK
Practice Address - State:NC
Practice Address - Zip Code:28532-2214
Practice Address - Country:US
Practice Address - Phone:252-622-9818
Practice Address - Fax:252-444-6800
Is Sole Proprietor?:No
Enumeration Date:2023-07-27
Last Update Date:2023-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCPO194961041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical