Provider Demographics
NPI:1952068587
Name:ROGERS, CANDICE JOINES (LMBT)
Entity Type:Individual
Prefix:
First Name:CANDICE
Middle Name:JOINES
Last Name:ROGERS
Suffix:
Gender:F
Credentials:LMBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:126 E MURPHY ST
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:NC
Mailing Address - Zip Code:27025-1920
Mailing Address - Country:US
Mailing Address - Phone:336-949-4348
Mailing Address - Fax:
Practice Address - Street 1:126 E MURPHY ST
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:NC
Practice Address - Zip Code:27025-1920
Practice Address - Country:US
Practice Address - Phone:336-949-4348
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-11-18
Last Update Date:2021-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC18795225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC18795OtherNC BOARD OF MASSAGE