Healthcare Provider Details

I. General information

NPI: 1730188277
Provider Name (Legal Business Name): CANDYCE S. MCLEOD NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/18/2005
Last Update Date: 12/08/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9302 MEDICAL PLAZA DRIVE, SUITE C LTC HEALTH SOLUTIONS
CHARLESTON SC
29406
US

IV. Provider business mailing address

1624 MAIN STREET AGAPE SENIOR PRIMARY CARE, INC., DBA LTC HEALTH SOLUTIO
COLUMBIA SC
29201
US

V. Phone/Fax

Practice location:
  • Phone: 843-797-0416
  • Fax: 843-847-4477
Mailing address:
  • Phone: 803-454-0365
  • Fax: 803-404-6000

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License Number45938
License Number StateSC
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number1155
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: