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1013217132
STACEY CANNON
LONG BEACH, CA
NPI
1013217132
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Entity Type
Individual
Gender
Male
Sole Proprietor ?
No
Primary Taxonomy
101YA0400X Counselor, Addiction (Substance Use Disorder)
Enumeration Date
2010-10-22
Last Update Date
2010-10-22
Business Address
-- STACEY CANNON
2008 PACIFIC AVE
LONG BEACH, CA 90806-4610
Phone number: 562-591-0011
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Mailing Address
-- STACEY CANNON
2008 PACIFIC AVE
LONG BEACH, CA 90806-4610
Phone number: 562-591-0011
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