Provider Demographics
NPI:1285857789
Name:ALLEN-STATEN, CANDACE DEVON (PSYD)
Entity Type:Individual
Prefix:DR
First Name:CANDACE
Middle Name:DEVON
Last Name:ALLEN-STATEN
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2550 AKERS MILL RD SE
Mailing Address - Street 2:APT E 15
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30339-3207
Mailing Address - Country:US
Mailing Address - Phone:937-369-6423
Mailing Address - Fax:
Practice Address - Street 1:110 EAGLES WALK
Practice Address - Street 2:SUITE 100
Practice Address - City:STOCKBRIDGE
Practice Address - State:GA
Practice Address - Zip Code:30281-7204
Practice Address - Country:US
Practice Address - Phone:770-507-6044
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-11
Last Update Date:2010-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPSY003320103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical