Provider Demographics
NPI:1831259324
Name:COTTON, CANDACE R (PHD)
Entity type:Individual
Prefix:
First Name:CANDACE
Middle Name:R
Last Name:COTTON
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10837 TUCKAHOE WAY
Mailing Address - Street 2:
Mailing Address - City:NORTH POTOMAC
Mailing Address - State:MD
Mailing Address - Zip Code:20878-4226
Mailing Address - Country:US
Mailing Address - Phone:301-279-9066
Mailing Address - Fax:301-279-9548
Practice Address - Street 1:10837 TUCKAHOE WAY
Practice Address - Street 2:
Practice Address - City:NORTH POTOMAC
Practice Address - State:MD
Practice Address - Zip Code:20878-4226
Practice Address - Country:US
Practice Address - Phone:301-279-9066
Practice Address - Fax:301-279-9548
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD2325103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD654413Medicare ID - Type Unspecified