Doctor Name: | NICOLE LYNN GANNON |
NPI Number: | 1174879209 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | LPC |
License Number: | PC006297 |
Business Practice Address: | 221 Penn Ave Suite 3000 Wilkinsburg, PA - 152212118 |
Business Phone Number: | 7244438900 |
Business Fax Number: | |
Mailing Address: | 221 Penn Ave, Suite 3000 WILKINSBURG |
State: | PA |
Postal Code: | 152212118 |
Phone Number: | 7244438900 |
Fax Number: | |
NPI Enumeration Date: | 07/26/2012 |
NPI Last Update Date: | 02/14/2015 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101YP2500X |
License Number: | PC006297 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | PA |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | Professional |
Taxonomy Definition: |