Provider Demographics
NPI:1275297277
Name:SCALES, CANDICE STATON
Entity Type:Individual
Prefix:
First Name:CANDICE
Middle Name:STATON
Last Name:SCALES
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8 HILLRISE CT
Mailing Address - Street 2:
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27405-9771
Mailing Address - Country:US
Mailing Address - Phone:336-554-1625
Mailing Address - Fax:
Practice Address - Street 1:2200 E MARKET ST STE C
Practice Address - Street 2:
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27401-6444
Practice Address - Country:US
Practice Address - Phone:336-554-1625
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-10-26
Last Update Date:2021-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker
No172A00000XOther Service ProvidersDriver
No175T00000XOther Service ProvidersPeer Specialist
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor