Provider Demographics
NPI:1194187054
Name:MCKAY, CANDACE R (MA, NCC, LPC)
Entity Type:Individual
Prefix:
First Name:CANDACE
Middle Name:R
Last Name:MCKAY
Suffix:
Gender:F
Credentials:MA, NCC, LPC
Other - Prefix:
Other - First Name:CANDACE
Other - Middle Name:
Other - Last Name:SUSSMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3708 BUXMONT RD
Mailing Address - Street 2:
Mailing Address - City:MARLTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08053-8511
Mailing Address - Country:US
Mailing Address - Phone:732-690-5610
Mailing Address - Fax:
Practice Address - Street 1:3708 BUXMONT RD
Practice Address - Street 2:
Practice Address - City:MARLTON
Practice Address - State:NJ
Practice Address - Zip Code:08053-8511
Practice Address - Country:US
Practice Address - Phone:732-690-5610
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-03-22
Last Update Date:2016-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37PC00570500101YP2500X
COLPC.0013414101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional