Provider Demographics
NPI:1396909560
Name:MCCALLIE, CANDICE A (BS)
Entity type:Individual
Prefix:
First Name:CANDICE
Middle Name:A
Last Name:MCCALLIE
Suffix:
Gender:F
Credentials:BS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8 COSMIC WAY
Mailing Address - Street 2:
Mailing Address - City:LOOKOUT MOUNTAIN
Mailing Address - State:GA
Mailing Address - Zip Code:30750-4750
Mailing Address - Country:US
Mailing Address - Phone:423-756-2740
Mailing Address - Fax:
Practice Address - Street 1:8 COSMIC WAY
Practice Address - Street 2:
Practice Address - City:LOOKOUT MOUNTAIN
Practice Address - State:GA
Practice Address - Zip Code:30750-4750
Practice Address - Country:US
Practice Address - Phone:423-756-2740
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-07-16
Last Update Date:2008-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health