| Doctor Name: | MRS. CARRIE ELLA CANNON |
| NPI Number: | 1154579977 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | M.A. |
| License Number: | |
| Business Practice Address: | 2410 Pine St Arkadelphia, AR - 719234335 |
| Business Phone Number: | 8702452223 |
| Business Fax Number: | 8702452225 |
| Mailing Address: | 355 Lamplighter Dr, BENTON |
| State: | AR |
| Postal Code: | 720159063 |
| Phone Number: | 5016172886 |
| Fax Number: | |
| NPI Enumeration Date: | 09/04/2008 |
| NPI Last Update Date: | 09/04/2008 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 1041C0700X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Social Worker |
| Taxonomy Specialization: | Clinical |
| Taxonomy Definition: | A social worker who holds a master |