Provider Demographics
NPI:1467827352
Name:ENZOR, CANDICE NACOLE (HST)
Entity Type:Individual
Prefix:
First Name:CANDICE
Middle Name:NACOLE
Last Name:ENZOR
Suffix:
Gender:F
Credentials:HST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:550 RIVERSTONE PKWY
Mailing Address - Street 2:APT. # D111
Mailing Address - City:CANTON
Mailing Address - State:GA
Mailing Address - Zip Code:30114-5661
Mailing Address - Country:US
Mailing Address - Phone:770-875-8153
Mailing Address - Fax:
Practice Address - Street 1:550 RIVERSTONE PKWY
Practice Address - Street 2:APT. # D111
Practice Address - City:CANTON
Practice Address - State:GA
Practice Address - Zip Code:30114-5661
Practice Address - Country:US
Practice Address - Phone:770-875-8153
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-12-03
Last Update Date:2015-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health