Healthcare Provider Details

I. General information

NPI: 1952615734
Provider Name (Legal Business Name): CANDICARES, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/03/2010
Last Update Date: 09/22/2022
Certification Date: 09/22/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4265 BROWNSBORO RD SUITE 150
WINSTON SALEM NC
27106-6194
US

IV. Provider business mailing address

4265 BROWNSBORO RD SUITE 150
WINSTON SALEM NC
27106-6194
US

V. Phone/Fax

Practice location:
  • Phone: 336-896-0700
  • Fax: 336-896-0701
Mailing address:
  • Phone: 336-896-0700
  • Fax: 336-896-0701

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number2713
License Number StateNC

VIII. Authorized Official

Name: DR. CANDACE LOUISE WASHINGTON
Title or Position: CEO/LICENSED PSYCHOLOGIST
Credential: PHD
Phone: 336-896-0700