Provider Demographics
NPI:1851538193
Name:HARDIN, CANDICE COLLEEN (MS, LLP)
Entity Type:Individual
Prefix:
First Name:CANDICE
Middle Name:COLLEEN
Last Name:HARDIN
Suffix:
Gender:F
Credentials:MS, LLP
Other - Prefix:
Other - First Name:CANDICE
Other - Middle Name:COLLEEN
Other - Last Name:RYAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS, LLP
Mailing Address - Street 1:3621 S STATE ST
Mailing Address - Street 2:700 KMS PLACE
Mailing Address - City:ANN ARBOR
Mailing Address - State:MI
Mailing Address - Zip Code:48108
Mailing Address - Country:US
Mailing Address - Phone:734-936-2047
Mailing Address - Fax:
Practice Address - Street 1:355 BRIARWOOD CIR.
Practice Address - Street 2:
Practice Address - City:ANN ARBOR
Practice Address - State:MI
Practice Address - Zip Code:48108-1605
Practice Address - Country:US
Practice Address - Phone:734-998-7710
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-01-08
Last Update Date:2009-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301010714103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist