Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
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MS. Brenda Gail Cannon, BAINPSYCHOLOGY

Individual provider Intellectual and/or Developmental Disabilities Residential Treatment Facility · NPI 1114490877

MS. Brenda Gail Cannon, BAINPSYCHOLOGY is an Intellectual and/or Developmental Disabilities Residential Treatment Facility in Raleigh, North Carolina. Practices as a sole proprietor. Licensed in North Carolina.

Licensed in
NC
In the registry since
2019
Specialties on file
2
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Practice location Address checks out

3105 Vico Ter
Raleigh, NC 27610-5951
Phone: (919) 637-8831
Fax: (919) 890-5578
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Intellectual and/or Developmental Disabilities Residential Treatment Facility (primary) Taxonomy 320600000X · Licence MHL-092-898 (NC)
Intellectual and/or Developmental Disabilities Residential Treatment Facility Taxonomy 320600000X (NC)

Record details

NPI number1114490877
Entity typeIndividual (Type 1)
GenderFemale
Credentials BAINPSYCHOLOGY
Sole proprietorYes
NPI enumeratedJanuary 5, 2019
Last updated in NPPESJanuary 5, 2019

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