Healthcare Provider Details

I. General information

NPI: 1588397541
Provider Name (Legal Business Name): CANDACE KAY WINKEL
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/07/2022
Last Update Date: 09/09/2025
Certification Date: 09/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

329 E JIMMIE LEEDS RD
GALLOWAY NJ
08205-4110
US

IV. Provider business mailing address

420 LINE ST
HAMMONTON NJ
08037-1241
US

V. Phone/Fax

Practice location:
  • Phone: 609-515-6040
  • Fax:
Mailing address:
  • Phone: 609-515-6040
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number37AC00721800
License Number StateNJ
# 2
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: