Provider Demographics
NPI:1972390896
Name:CANNON, GINGER MOORE
Entity type:Individual
Prefix:
First Name:GINGER
Middle Name:MOORE
Last Name:CANNON
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 1:438 GUILFORD RD
Mailing Address - Street 2:
Mailing Address - City:ROCK HILL
Mailing Address - State:SC
Mailing Address - Zip Code:29732-1940
Mailing Address - Country:US
Mailing Address - Phone:843-312-0670
Mailing Address - Fax:
Practice Address - Street 1:424 ESTHER CT
Practice Address - Street 2:
Practice Address - City:FORT MILL
Practice Address - State:SC
Practice Address - Zip Code:29708-5707
Practice Address - Country:US
Practice Address - Phone:201-906-1025
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-04-23
Last Update Date:2025-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC244053101YS0200X
SC9048101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YS0200XBehavioral Health & Social Service ProvidersCounselorSchool