Provider Demographics
NPI:1508622770
Name:CROSSNINE, CANDICE BLAIR (MS)
Entity Type:Individual
Prefix:MS
First Name:CANDICE
Middle Name:BLAIR
Last Name:CROSSNINE
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6219 FOREST GROVE DR
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38119-6535
Mailing Address - Country:US
Mailing Address - Phone:901-262-5271
Mailing Address - Fax:
Practice Address - Street 1:6219 FOREST GROVE DR
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38119-6535
Practice Address - Country:US
Practice Address - Phone:901-262-5271
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-02-26
Last Update Date:2024-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Single Specialty