Provider Demographics
NPI:1710030549
Name:SMITH, KANDI LEANNE (CADC II)
Entity Type:Individual
Prefix:
First Name:KANDI
Middle Name:LEANNE
Last Name:SMITH
Suffix:
Gender:F
Credentials:CADC II
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1400 N NORMA ST STE 133
Mailing Address - Street 2:
Mailing Address - City:RIDGECREST
Mailing Address - State:CA
Mailing Address - Zip Code:93555-2577
Mailing Address - Country:US
Mailing Address - Phone:760-499-7406
Mailing Address - Fax:760-499-7479
Practice Address - Street 1:1400 N NORMA ST STE 133
Practice Address - Street 2:
Practice Address - City:RIDGECREST
Practice Address - State:CA
Practice Address - Zip Code:93555-2577
Practice Address - Country:US
Practice Address - Phone:760-499-7406
Practice Address - Fax:760-499-7479
Is Sole Proprietor?:No
Enumeration Date:2007-01-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA8574606101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)