Provider Demographics
NPI:1760084073
Name:HARRIS, CANDY L
Entity Type:Individual
Prefix:MS
First Name:CANDY
Middle Name:L
Last Name:HARRIS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:CANDY
Other - Middle Name:L
Other - Last Name:HARRIS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:CODING SPECIALIST
Mailing Address - Street 1:4017 NORTH AVE APT 1
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23222-1149
Mailing Address - Country:US
Mailing Address - Phone:804-401-2887
Mailing Address - Fax:
Practice Address - Street 1:4017 NORTH AVE APT 1
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23222-1149
Practice Address - Country:US
Practice Address - Phone:804-401-2887
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-11
Last Update Date:2020-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA175T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA30009765OtherLIFE COACH