Healthcare Provider Details

I. General information

NPI: 1891492799
Provider Name (Legal Business Name): DESTINIE CANDIS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/10/2023
Last Update Date: 02/10/2023
Certification Date: 02/10/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5768 S SEMORAN BLVD
ORLANDO FL
32822-4818
US

IV. Provider business mailing address

204 W SAUNDERS ST
PLANT CITY FL
33563-2402
US

V. Phone/Fax

Practice location:
  • Phone: 407-896-2323
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: