Provider Demographics
NPI:1518601939
Name:MARTIN, CANDICE LEIGH
Entity Type:Individual
Prefix:
First Name:CANDICE
Middle Name:LEIGH
Last Name:MARTIN
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 1:419 101ST AVE SE APT H39
Mailing Address - Street 2:
Mailing Address - City:LAKE STEVENS
Mailing Address - State:WA
Mailing Address - Zip Code:98258-1927
Mailing Address - Country:US
Mailing Address - Phone:425-572-8500
Mailing Address - Fax:
Practice Address - Street 1:419 101ST AVE SE APT H39
Practice Address - Street 2:
Practice Address - City:LAKE STEVENS
Practice Address - State:WA
Practice Address - Zip Code:98258-1927
Practice Address - Country:US
Practice Address - Phone:425-572-8500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-04-21
Last Update Date:2022-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor