Provider Demographics
NPI:1376650507
Name:BRINK, KANDYCE KAYE (MA LMSW LPC)
Entity Type:Individual
Prefix:MS
First Name:KANDYCE
Middle Name:KAYE
Last Name:BRINK
Suffix:
Gender:F
Credentials:MA LMSW LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 553
Mailing Address - Street 2:
Mailing Address - City:SAINT JOSEPH
Mailing Address - State:MI
Mailing Address - Zip Code:49085-0553
Mailing Address - Country:US
Mailing Address - Phone:269-983-5600
Mailing Address - Fax:269-927-6146
Practice Address - Street 1:1804 COLFAX AVE STE 1
Practice Address - Street 2:
Practice Address - City:BENTON HARBOR
Practice Address - State:MI
Practice Address - Zip Code:49022-6711
Practice Address - Country:US
Practice Address - Phone:269-983-5600
Practice Address - Fax:269-927-6146
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-24
Last Update Date:2014-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6401002128101YP2500X
MI68010604721041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional