Provider Demographics
NPI:1013311695
Name:LEBRON, KANDIS RENEE
Entity Type:Individual
Prefix:MRS
First Name:KANDIS
Middle Name:RENEE
Last Name:LEBRON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:135 W 34TH ST
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:DE
Mailing Address - Zip Code:19802-2702
Mailing Address - Country:US
Mailing Address - Phone:302-344-1796
Mailing Address - Fax:
Practice Address - Street 1:135 W 34TH ST
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:DE
Practice Address - Zip Code:19802-2702
Practice Address - Country:US
Practice Address - Phone:302-344-1796
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-10-10
Last Update Date:2014-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YS0200XBehavioral Health & Social Service ProvidersCounselorSchool