Provider Demographics
NPI:1033556063
Name:CANDOR COUNSELING LLC
Entity Type:Organization
Organization Name:CANDOR COUNSELING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:EDIE
Authorized Official - Middle Name:J
Authorized Official - Last Name:SIEMANN
Authorized Official - Suffix:
Authorized Official - Credentials:LMHC
Authorized Official - Phone:352-284-3747
Mailing Address - Street 1:2830 NW 41ST ST
Mailing Address - Street 2:SUITE J
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32606-6667
Mailing Address - Country:US
Mailing Address - Phone:352-284-3747
Mailing Address - Fax:
Practice Address - Street 1:2830 NW 41ST ST
Practice Address - Street 2:SUITE J
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32606-6667
Practice Address - Country:US
Practice Address - Phone:352-284-3747
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-05-31
Last Update Date:2014-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH 11836101YM0800X
FLMT2804106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Multi-Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty