Provider Demographics
NPI:1174879209
Name:GANNON, NICOLE LYNN (LPC)
Entity type:Individual
Prefix:
First Name:NICOLE
Middle Name:LYNN
Last Name:GANNON
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:221 PENN AVE
Mailing Address - Street 2:SUITE 3000
Mailing Address - City:WILKINSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:15221-2118
Mailing Address - Country:US
Mailing Address - Phone:724-443-8900
Mailing Address - Fax:
Practice Address - Street 1:221 PENN AVE
Practice Address - Street 2:SUITE 3000
Practice Address - City:WILKINSBURG
Practice Address - State:PA
Practice Address - Zip Code:15221-2118
Practice Address - Country:US
Practice Address - Phone:724-443-8900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-07-26
Last Update Date:2015-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPC006297101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional