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MS. BRENDA GAIL CANNON BA IN PSYCHOLOGY
NPI 1114490877
Residential Treatment Facility, Intellectual and/or Developmental Disabilities in Raleigh, NC

Active since January 05, 2019
3105 VICO TER, RALEIGH, NC 27610(919) 637-8831(919) 890-5578 Get Directions Write a Review

NPPES record last updated: January 5, 2019. Verified against the NPPES registry weekly; last sync: August 02, 2026.

About Ms. Brenda Gail Cannon Ba In Psychology NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

MS. BRENDA GAIL CANNON BA IN PSYCHOLOGY (NPI 1114490877) is an individual residential treatment facility, intellectual and/or developmental disabilities provider in Raleigh, North Carolina, licensed in North Carolina (MHL-092-898) and active in the NPI registry since January 2019.

NPPES Registry Identity

NPI1114490877
Entity TypeIndividualFemale
Primary Taxonomy320600000X
Provider Legal NameMS. BRENDA GAIL CANNONCredential: BA IN PSYCHOLOGY
Location Address3105 VICO TERRaleigh, NC 27610-5951
Mailing Address1301 Southgate DrRaleigh, NC 27610-5090 · (919) 637-8831
Phone(919) 637-8831
Fax(919) 890-5578
Sole ProprietorYes
Enumeration DateJanuary 5, 2019
✔ NPI 1114490877 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyResidential Treatment Facility, Intellectual and/or Developmental DisabilitiesResidential Treatment Facilities
Taxonomy Code320600000X
License✔ Licensed in NC · MHL-092-898
Definition
A residential facility that provides habilitation services and other care and treatment to adults or children diagnosed with developmental and intellectual disabilities and are not able to live independently.
3105 VICO TER, Raleigh, NC 27610
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Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Brenda Cannon's NPI number?

The NPI number for Brenda Cannon is 1114490877. It was assigned to this individual provider in the NPPES registry on January 5, 2019.

Where is Brenda Cannon located?

Brenda Cannon practices at 3105 Vico Ter, Raleigh, NC 27610. The listed phone number is (919) 637-8831.

What is Brenda Cannon's specialty?

The primary specialty registered for this NPI is Residential Treatment Facility, Intellectual and/or Developmental Disabilities with taxonomy code 320600000X.

When was this NPI record last updated?

The NPPES record for Brenda Cannon was last updated on January 5, 2019. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 7 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.