Healthcare Provider Details

I. General information

NPI: 1306757026
Provider Name (Legal Business Name): KANDACE TAWIA LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/14/2026
Last Update Date: 09/14/2026
Certification Date: 09/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

90 CARRERA RD
STOCKBRIDGE GA
30281-4388
US

IV. Provider business mailing address

90 CARRERA RD
STOCKBRIDGE GA
30281-4388
US

V. Phone/Fax

Practice location:
  • Phone: 678-235-8845
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberCSW010663
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: