Provider Demographics
NPI:1245886225
Name:WASHINGTON, CANDACE S (MA, RBHT)
Entity type:Individual
Prefix:
First Name:CANDACE
Middle Name:S
Last Name:WASHINGTON
Suffix:
Gender:F
Credentials:MA, RBHT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:201 S HOLLY AVE
Mailing Address - Street 2:
Mailing Address - City:SANFORD
Mailing Address - State:FL
Mailing Address - Zip Code:32771-1179
Mailing Address - Country:US
Mailing Address - Phone:321-578-8462
Mailing Address - Fax:
Practice Address - Street 1:201 S HOLLY AVE
Practice Address - Street 2:
Practice Address - City:SANFORD
Practice Address - State:FL
Practice Address - Zip Code:32771-1179
Practice Address - Country:US
Practice Address - Phone:321-578-8462
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-08-14
Last Update Date:2019-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL3747A0650X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747A0650XNursing Service Related ProvidersTechnicianAttendant Care Provider