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General NPI Number Information
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NPI Number | 1255560769
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Entity Type | Individual
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Provider Name | CANDACE MAXWELL L.M.H.C.
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Gender | Female
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Dates
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Enumeration Date | 07/06/2009
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Last Update Date | 06/16/2018
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Provider Practice Location Address
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Address Line | 1150 N 12TH AVE
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City | PENSACOLA
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State | FL
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Zip | 32501-3308
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Country | US
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Telephone | 850-290-7768
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Fax | 850-273-6495
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Provider Business Mailing Address
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Address Line | 1150 N 12TH AVE
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City | PENSACOLA
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State | FL
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Zip | 32501-3308
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Country | US
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Telephone | 850-898-0988
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Fax | 850-273-6495
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 9224
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License Number State | FL
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Taxonomy #3
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | MH9224
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License Number State | FL
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