Healthcare Provider Details

I. General information

NPI: 1487450102
Provider Name (Legal Business Name): CANDICA OKOR
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/22/2025
Last Update Date: 12/03/2025
Certification Date: 12/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

233 12TH ST STE 621A
COLUMBUS GA
31901-2415
US

IV. Provider business mailing address

233 12TH ST STE 621A
COLUMBUS GA
31901-2415
US

V. Phone/Fax

Practice location:
  • Phone: 762-261-0877
  • Fax:
Mailing address:
  • Phone: 762-261-0877
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: