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General NPI Number Information
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NPI Number | 1851605083
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Entity Type | Individual
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Provider Name | CANDICE NICOLE CLAIBORNE PHD
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Gender | Female
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Dates
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Enumeration Date | 07/29/2010
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Last Update Date | 02/21/2019
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Provider Practice Location Address
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Address Line | 701 BROAD ST STE 350
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City | ROME
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State | GA
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Zip | 30161-3092
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Country | US
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Telephone | 706-295-2028
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Fax | 706-295-2062
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Provider Business Mailing Address
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Address Line | 221 TECHNOLOGY PKWY NW
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City | ROME
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State | GA
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Zip | 30165-1369
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Country | US
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Telephone | 706-295-5331
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Fax |
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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 | 103TC1900X
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Taxonomy Name | Counseling Psychologist
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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 | 103TC2200X
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Taxonomy Name | Clinical Child & Adolescent Psychologist
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | PSY003955
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License Number State | GA
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