Provider Demographics
NPI:1205273570
Name:EDWARDS, CANDACE (IMH18911)
Entity type:Individual
Prefix:
First Name:CANDACE
Middle Name:
Last Name:EDWARDS
Suffix:
Gender:F
Credentials:IMH18911
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1403 CRISTO REY PL
Mailing Address - Street 2:
Mailing Address - City:PLANT CITY
Mailing Address - State:FL
Mailing Address - Zip Code:33566-8405
Mailing Address - Country:US
Mailing Address - Phone:813-400-4482
Mailing Address - Fax:
Practice Address - Street 1:10150 HIGHLAND MANOR DR.
Practice Address - Street 2:SUITE 200
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33610
Practice Address - Country:US
Practice Address - Phone:813-314-2200
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-05-28
Last Update Date:2020-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
1205273570OtherNPI