Provider Demographics
NPI:1669003687
Name:WITHERSPOON, KANDICE J (LPC)
Entity Type:Individual
Prefix:
First Name:KANDICE
Middle Name:J
Last Name:WITHERSPOON
Suffix:
Gender:F
Credentials:LPC
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Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:3535 MARKET STREET
Mailing Address - Street 2:MEZZANINE LEVEL
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19104-3317
Mailing Address - Country:US
Mailing Address - Phone:215-764-4100
Mailing Address - Fax:215-746-4116
Practice Address - Street 1:3535 MARKET STREET
Practice Address - Street 2:MEZZANINE LEVEL
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19104-3317
Practice Address - Country:US
Practice Address - Phone:215-764-4100
Practice Address - Fax:215-746-4116
Is Sole Proprietor?:Yes
Enumeration Date:2020-01-29
Last Update Date:2022-02-23
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PAPC009305101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional