Provider Demographics
NPI:1013040104
Name:CHILDERS, CANDACE KAY (MA)
Entity Type:Individual
Prefix:MRS
First Name:CANDACE
Middle Name:KAY
Last Name:CHILDERS
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:145 W PARKER RD STE A
Mailing Address - Street 2:
Mailing Address - City:MORGANTON
Mailing Address - State:NC
Mailing Address - Zip Code:28655-4649
Mailing Address - Country:US
Mailing Address - Phone:828-433-5177
Mailing Address - Fax:828-433-1127
Practice Address - Street 1:145 W PARKER RD STE A
Practice Address - Street 2:
Practice Address - City:MORGANTON
Practice Address - State:NC
Practice Address - Zip Code:28655-4649
Practice Address - Country:US
Practice Address - Phone:828-433-5177
Practice Address - Fax:828-433-1127
Is Sole Proprietor?:No
Enumeration Date:2007-03-14
Last Update Date:2014-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1477103TM1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TM1800XBehavioral Health & Social Service ProvidersPsychologistIntellectual & Developmental Disabilities
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC046N2OtherBCBS PROVIDER NUMBER