Provider Demographics
NPI:1760677199
Name:KANDICE FRICKE-SMITH, LPC
Entity Type:Organization
Organization Name:KANDICE FRICKE-SMITH, LPC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHOTHERAPIST
Authorized Official - Prefix:MS
Authorized Official - First Name:KANDICE
Authorized Official - Middle Name:K
Authorized Official - Last Name:FRICKE-SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:MS, LPC
Authorized Official - Phone:361-814-0900
Mailing Address - Street 1:700 EVERHART RD
Mailing Address - Street 2:SUITE, H-21
Mailing Address - City:CORPUS CHRISTI
Mailing Address - State:TX
Mailing Address - Zip Code:78411-1926
Mailing Address - Country:US
Mailing Address - Phone:361-814-0900
Mailing Address - Fax:361-814-5200
Practice Address - Street 1:700 EVERHART RD
Practice Address - Street 2:SUITE, H-21
Practice Address - City:CORPUS CHRISTI
Practice Address - State:TX
Practice Address - Zip Code:78411-1926
Practice Address - Country:US
Practice Address - Phone:361-814-0900
Practice Address - Fax:361-814-5200
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-10
Last Update Date:2007-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX15089101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty