Provider Demographics
NPI:1043516750
Name:CANNON, WILLIAM ALVIS (LCSW)
Entity type:Individual
Prefix:
First Name:WILLIAM
Middle Name:ALVIS
Last Name:CANNON
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:208 ELIZABETH ANN CT
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78213-1888
Mailing Address - Country:US
Mailing Address - Phone:210-541-8035
Mailing Address - Fax:
Practice Address - Street 1:208 ELIZABETH ANN CT
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78213-1888
Practice Address - Country:US
Practice Address - Phone:210-541-8035
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-01-28
Last Update Date:2011-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX097101041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical