| Nedra Cannon Lcsw Llc | |
|
411 W Lake Lansing Rd Ste C120 East Lansing MI 48823-8483 | |
| (517) 219-5761 | |
| Not Available |
| Full Name | Nedra Cannon Lcsw Llc |
|---|---|
| Speciality | Clinic/Center |
| Location | 411 W Lake Lansing Rd Ste C120, East Lansing, Michigan |
| Authorized Official Name and Position | Nedra Cannon (OWNER) |
| Authorized Official Contact | 5172195761 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Nedra Cannon Lcsw Llc Po Box 26162 Lansing MI 48909-6162 Ph: () - | Nedra Cannon Lcsw Llc 411 W Lake Lansing Rd Ste C120 East Lansing MI 48823-8483 Ph: (517) 219-5761 |
| NPI Number | 1548895626 |
|---|---|
| Provider Enumeration Date | 03/09/2020 |
| Last Update Date | 03/09/2020 |
| Certification Date | 03/09/2020 |
| Medicare PECOS PAC ID | 9638509383 |
|---|---|
| Medicare Enrollment ID | O20200420002485 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1548895626 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0850X | Clinic/center - Adult Mental Health | (* (Not Available)) | Primary |
| Provider Name | Nedra Cannon |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1487746012 PECOS PAC ID: 0446484299 Enrollment ID: I20131009001481 |
| Provider Name | Alexis M Phillips |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1538634175 PECOS PAC ID: 7113261983 Enrollment ID: I20181205001080 |
| Provider Name | Eneziah Walters |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1194383802 PECOS PAC ID: 0749690840 Enrollment ID: I20201030001250 |
| Provider Name | Leeshanda Smith |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1083135172 PECOS PAC ID: 7517358039 Enrollment ID: I20211216002704 |
| Provider Name | Lesley Gant |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1578150793 PECOS PAC ID: 6002286507 Enrollment ID: I20221227001628 |
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