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General NPI Number Information
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NPI Number | 1427485309
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Entity Type | Organization
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Legal Business Name | CANDIS COUNSELING & THERAPEUTIC SERVICES LLC
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Dates
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Enumeration Date | 10/09/2013
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Last Update Date | 10/15/2013
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Provider Practice Location Address
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Address Line | 1103 N WHEELER ST STE C
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City | PLANT CITY
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State | FL
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Zip | 33563-3112
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Country | US
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Telephone | 813-754-1739
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Fax | 813-659-1292
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Provider Business Mailing Address
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Address Line | 1103 N WHEELER ST STE C
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City | PLANT CITY
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State | FL
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Zip | 33563-3112
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Country | US
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Telephone | 813-754-1739
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Fax | 813-659-1292
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Authorized Official
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Title or Position | OWNER/LICENSED THERAPIST
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Name | MR. LAVASAOUS A CANDIS
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Credential | LMHC, CAP
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Telephone | 813-754-1739
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number | 11677
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License Number State | FL
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