Provider Demographics
NPI:1568914604
Name:NORRIS-BROWN, CANDICE
Entity Type:Individual
Prefix:DR
First Name:CANDICE
Middle Name:
Last Name:NORRIS-BROWN
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 1:3350 NORTHLAKE PKWY NE STE B-3
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30345-2204
Mailing Address - Country:US
Mailing Address - Phone:404-202-2061
Mailing Address - Fax:
Practice Address - Street 1:1135 HUNTINGTON PLACE CIR
Practice Address - Street 2:
Practice Address - City:LITHONIA
Practice Address - State:GA
Practice Address - Zip Code:30058-3036
Practice Address - Country:US
Practice Address - Phone:404-202-2061
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-10-25
Last Update Date:2023-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEPC0011040101YP2500X
VA0701005764101YP2500X
GALPC004442101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA815419451OtherCOMMERCIAL INSURANCE