Provider Demographics
NPI:1093010324
Name:MCCANDLISH, KIKUKO (MA, LPC, NCC)
Entity Type:Individual
Prefix:MRS
First Name:KIKUKO
Middle Name:
Last Name:MCCANDLISH
Suffix:
Gender:F
Credentials:MA, LPC, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:27990 TRAILWOOD CT
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48331-2946
Mailing Address - Country:US
Mailing Address - Phone:248-553-1973
Mailing Address - Fax:248-553-1973
Practice Address - Street 1:27990 TRAILWOOD CT
Practice Address - Street 2:
Practice Address - City:FARMINGTON HILLS
Practice Address - State:MI
Practice Address - Zip Code:48331-2946
Practice Address - Country:US
Practice Address - Phone:248-553-1973
Practice Address - Fax:248-553-1973
Is Sole Proprietor?:Yes
Enumeration Date:2011-01-18
Last Update Date:2011-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6401009220101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional