Healthcare Provider Details

I. General information

NPI: 1275297277
Provider Name (Legal Business Name): CANDICE STATON SCALES
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/26/2021
Last Update Date: 11/04/2021
Certification Date: 11/04/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2200 E MARKET ST STE C
GREENSBORO NC
27401-6444
US

IV. Provider business mailing address

8 HILLRISE CT
GREENSBORO NC
27405-9771
US

V. Phone/Fax

Practice location:
  • Phone: 336-554-1625
  • Fax:
Mailing address:
  • Phone: 336-554-1625
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code172A00000X
TaxonomyDriver
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number
License Number StateNULL
# 4
Primary TaxonomyN
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: