Provider Demographics
NPI:1184771388
Name:SILVESTRI, KANDIS A (MSED, LPC)
Entity type:Individual
Prefix:MISS
First Name:KANDIS
Middle Name:A
Last Name:SILVESTRI
Suffix:
Gender:F
Credentials:MSED, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2277 SWANSON AVE
Mailing Address - Street 2:STE B
Mailing Address - City:LAKE HAVASU CITY
Mailing Address - State:AZ
Mailing Address - Zip Code:86403-5998
Mailing Address - Country:US
Mailing Address - Phone:928-854-0110
Mailing Address - Fax:928-854-0112
Practice Address - Street 1:2277 SWANSON AVE
Practice Address - Street 2:STE B
Practice Address - City:LAKE HAVASU CITY
Practice Address - State:AZ
Practice Address - Zip Code:86403-5998
Practice Address - Country:US
Practice Address - Phone:928-854-0110
Practice Address - Fax:928-854-0112
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-03
Last Update Date:2010-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLPC-12176101YM0800X
AZLPC12176101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health