Provider Demographics
NPI:1689369928
Name:CORDIAL, CANDACE (MFT)
Entity Type:Individual
Prefix:
First Name:CANDACE
Middle Name:
Last Name:CORDIAL
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1000 WALNUT ST APT 1812
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19107-5854
Mailing Address - Country:US
Mailing Address - Phone:724-619-1075
Mailing Address - Fax:
Practice Address - Street 1:1000 WALNUT ST APT 1812
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19107-5854
Practice Address - Country:US
Practice Address - Phone:724-619-1075
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-04-11
Last Update Date:2023-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health