Provider Demographics
NPI:1689859910
Name:BRANNON, CANDACE NICOLE (MS, CCLS)
Entity Type:Individual
Prefix:MISS
First Name:CANDACE
Middle Name:NICOLE
Last Name:BRANNON
Suffix:
Gender:F
Credentials:MS, CCLS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:55 BAY DR
Mailing Address - Street 2:UNIT 5201
Mailing Address - City:NICEVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32578-4156
Mailing Address - Country:US
Mailing Address - Phone:662-352-6766
Mailing Address - Fax:
Practice Address - Street 1:55 BAY DR
Practice Address - Street 2:UNIT 5201
Practice Address - City:NICEVILLE
Practice Address - State:FL
Practice Address - Zip Code:32578-4156
Practice Address - Country:US
Practice Address - Phone:662-352-6766
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-06
Last Update Date:2008-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor