Provider Demographics
NPI:1588037519
Name:PROCTOR, KANDICE APPLEBY (MSW, RCSWI)
Entity Type:Individual
Prefix:
First Name:KANDICE
Middle Name:APPLEBY
Last Name:PROCTOR
Suffix:
Gender:F
Credentials:MSW, RCSWI
Other - Prefix:
Other - First Name:KANDICE
Other - Middle Name:BROOKE
Other - Last Name:APPLEBY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSW, RCSWI
Mailing Address - Street 1:PO BOX 751803
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28275-1803
Mailing Address - Country:US
Mailing Address - Phone:336-718-3550
Mailing Address - Fax:336-277-1825
Practice Address - Street 1:175 KIMEL PARK DR STE 100
Practice Address - Street 2:
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27103-6951
Practice Address - Country:US
Practice Address - Phone:336-718-3550
Practice Address - Fax:336-277-1825
Is Sole Proprietor?:Yes
Enumeration Date:2015-11-13
Last Update Date:2021-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLISW8524104100000X
NCC0135421041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker