Provider Demographics
NPI:1417744939
Name:CANNNON, TEIONNA
Entity type:Individual
Prefix:
First Name:TEIONNA
Middle Name:
Last Name:CANNNON
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3552 COLLINS BLVD STE D
Mailing Address - Street 2:
Mailing Address - City:CHESAPEAKE
Mailing Address - State:VA
Mailing Address - Zip Code:23321-5264
Mailing Address - Country:US
Mailing Address - Phone:757-529-0050
Mailing Address - Fax:757-529-0050
Practice Address - Street 1:3552 COLLINS BLVD STE D
Practice Address - Street 2:
Practice Address - City:CHESAPEAKE
Practice Address - State:VA
Practice Address - Zip Code:23321-5264
Practice Address - Country:US
Practice Address - Phone:757-529-0050
Practice Address - Fax:757-529-0050
Is Sole Proprietor?:No
Enumeration Date:2025-04-21
Last Update Date:2025-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor