Provider Demographics
NPI:1922824176
Name:ARWINE, CANDY CHANEL
Entity type:Individual
Prefix:
First Name:CANDY CHANEL
Middle Name:
Last Name:ARWINE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:212 WALNUT ST APT 449
Mailing Address - Street 2:
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37403-4609
Mailing Address - Country:US
Mailing Address - Phone:305-345-7923
Mailing Address - Fax:
Practice Address - Street 1:200 W MARTIN LUTHER KING BLVD STE 1000
Practice Address - Street 2:
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37402-2571
Practice Address - Country:US
Practice Address - Phone:305-345-7923
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-12-03
Last Update Date:2024-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN24-389764103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst