Provider Demographics
NPI:1952615734
Name:CANDICARES, PLLC
Entity type:Organization
Organization Name:CANDICARES, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/LICENSED PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:CANDACE
Authorized Official - Middle Name:LOUISE
Authorized Official - Last Name:WASHINGTON
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:336-896-0700
Mailing Address - Street 1:4265 BROWNSBORO RD
Mailing Address - Street 2:SUITE 150
Mailing Address - City:WINSTON SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27106-6194
Mailing Address - Country:US
Mailing Address - Phone:336-896-0700
Mailing Address - Fax:336-896-0701
Practice Address - Street 1:4265 BROWNSBORO RD
Practice Address - Street 2:SUITE 150
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27106-6194
Practice Address - Country:US
Practice Address - Phone:336-896-0700
Practice Address - Fax:336-896-0701
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-08-03
Last Update Date:2022-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2713103TC1900X
103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty
No103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounselingGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6008436Medicaid