Provider Demographics
NPI:1124457304
Name:CANNON, FATINA (LPC LAC)
Entity type:Individual
Prefix:
First Name:FATINA
Middle Name:
Last Name:CANNON
Suffix:
Gender:F
Credentials:LPC LAC
Other - Prefix:
Other - First Name:FATINA
Other - Middle Name:
Other - Last Name:HINDI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPC
Mailing Address - Street 1:2115 W 32ND AVE UNIT 4
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80211-3449
Mailing Address - Country:US
Mailing Address - Phone:720-526-0893
Mailing Address - Fax:
Practice Address - Street 1:2115 W 32ND AVE UNIT 4
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80211-3449
Practice Address - Country:US
Practice Address - Phone:720-526-0893
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-11-07
Last Update Date:2024-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO11699101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional