Provider Demographics
NPI:1639638935
Name:HOWARD, CANDACE NICOLE
Entity Type:Individual
Prefix:
First Name:CANDACE
Middle Name:NICOLE
Last Name:HOWARD
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 1:1638 BATTLEFIELD PKWY
Mailing Address - Street 2:
Mailing Address - City:FORT OGLETHORPE
Mailing Address - State:GA
Mailing Address - Zip Code:30742-4016
Mailing Address - Country:US
Mailing Address - Phone:706-841-0500
Mailing Address - Fax:706-841-0502
Practice Address - Street 1:1638 BATTLEFIELD PKWY
Practice Address - Street 2:
Practice Address - City:FORT OGLETHORPE
Practice Address - State:GA
Practice Address - Zip Code:30742-4016
Practice Address - Country:US
Practice Address - Phone:706-841-0500
Practice Address - Fax:706-841-0502
Is Sole Proprietor?:No
Enumeration Date:2019-03-16
Last Update Date:2023-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPC010803101YM0800X
101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health