Healthcare Provider Details

I. General information

NPI: 1619883428
Provider Name (Legal Business Name): MS. CANDICE TENEE HARRELL
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/21/2026
Last Update Date: 08/21/2026
Certification Date: 08/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1477 NC 24-87
CAMERON NC
28326-6752
US

IV. Provider business mailing address

57 COTTSWOLD LN
SPRING LAKE NC
28390-7053
US

V. Phone/Fax

Practice location:
  • Phone: 910-497-0073
  • Fax:
Mailing address:
  • Phone: 910-203-2893
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: