Provider Demographics
NPI:1225768435
Name:FORD, KANDACE D (LCSW)
Entity Type:Individual
Prefix:
First Name:KANDACE
Middle Name:D
Last Name:FORD
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3905 HIXSON PIKE STE 103
Mailing Address - Street 2:
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37415-3569
Mailing Address - Country:US
Mailing Address - Phone:423-756-1506
Mailing Address - Fax:423-756-1909
Practice Address - Street 1:3905 HIXSON PIKE STE 103
Practice Address - Street 2:
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37415-3569
Practice Address - Country:US
Practice Address - Phone:423-756-1506
Practice Address - Fax:423-756-1909
Is Sole Proprietor?:No
Enumeration Date:2022-06-13
Last Update Date:2023-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN80101041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical