Healthcare Provider Details

I. General information

NPI: 1538419221
Provider Name (Legal Business Name): CANDACE HUNTER MARTEN PSYD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: CANDACE HUNTER

II. Dates (important events)

Enumeration Date: 09/11/2012
Last Update Date: 08/12/2024
Certification Date: 08/12/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

619 19TH ST S
BIRMINGHAM AL
35233-1900
US

IV. Provider business mailing address

PO BOX 55310
BIRMINGHAM AL
35255-5310
US

V. Phone/Fax

Practice location:
  • Phone: 404-210-3346
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103G00000X
TaxonomyClinical Neuropsychologist
License NumberPSY003559
License Number StateGA
# 2
Primary TaxonomyY
Taxonomy Code103G00000X
TaxonomyClinical Neuropsychologist
License Number2355
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: