Provider Demographics
NPI:1639779135
Name:KANDIE, STEPHANIE (MA, LADC, LPCC)
Entity Type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:
Last Name:KANDIE
Suffix:
Gender:F
Credentials:MA, LADC, LPCC
Other - Prefix:
Other - First Name:STEPHANIE
Other - Middle Name:ENOLA
Other - Last Name:CONTRERAS ROMERO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:5380 BOUNTY ST SE
Mailing Address - Street 2:
Mailing Address - City:PRIOR LAKE
Mailing Address - State:MN
Mailing Address - Zip Code:55372-2501
Mailing Address - Country:US
Mailing Address - Phone:763-327-7061
Mailing Address - Fax:612-488-0596
Practice Address - Street 1:5380 BOUNTY ST SE
Practice Address - Street 2:
Practice Address - City:PRIOR LAKE
Practice Address - State:MN
Practice Address - Zip Code:55372-2501
Practice Address - Country:US
Practice Address - Phone:763-327-7061
Practice Address - Fax:612-488-0596
Is Sole Proprietor?:No
Enumeration Date:2020-10-26
Last Update Date:2022-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)