Provider Demographics
NPI:1538496260
Name:MONTGOMERY, CANDIE RENEE (BS)
Entity Type:Individual
Prefix:
First Name:CANDIE
Middle Name:RENEE
Last Name:MONTGOMERY
Suffix:
Gender:F
Credentials:BS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:120 HYRNE DR
Mailing Address - Street 2:
Mailing Address - City:GOOSE CREEK
Mailing Address - State:SC
Mailing Address - Zip Code:29445-7331
Mailing Address - Country:US
Mailing Address - Phone:270-799-5767
Mailing Address - Fax:
Practice Address - Street 1:61 SAINT MARGARET ST
Practice Address - Street 2:
Practice Address - City:CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29403-3638
Practice Address - Country:US
Practice Address - Phone:843-297-8470
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-11-18
Last Update Date:2009-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst