Provider Demographics
NPI:1780805275
Name:REED, CANDACE MATTHEWS (LPC)
Entity type:Individual
Prefix:
First Name:CANDACE
Middle Name:MATTHEWS
Last Name:REED
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:CANDACE
Other - Middle Name:MATTHEWS
Other - Last Name:BUTLER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 2009
Mailing Address - Street 2:
Mailing Address - City:DOUGLAS
Mailing Address - State:GA
Mailing Address - Zip Code:31534-2009
Mailing Address - Country:US
Mailing Address - Phone:912-384-4357
Mailing Address - Fax:912-384-4356
Practice Address - Street 1:617 WARD ST E
Practice Address - Street 2:
Practice Address - City:DOUGLAS
Practice Address - State:GA
Practice Address - Zip Code:31533-0301
Practice Address - Country:US
Practice Address - Phone:912-384-4357
Practice Address - Fax:912-384-4356
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-01
Last Update Date:2015-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPC004795101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA003111635AMedicaid
GA003111635AMedicaid