MEDICARE: CANDY GODWIN WOODS LPC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YP2500X	Professional Counselor	4716	SC

General Provider Information

NPI Number	:	1275559031
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CANDY GODWIN WOODS LPC

Provider Business Mailing Address
First Line	:	3874 RENEE DR
Second Line	:	UNIT F
City	:	MYRTLE BEACH
State	:	SC
Zip	:	29579-4108
Country	:	US
Telephone Number	:	843-458-3342
Fax Number	:

Provider Business Practice Location Address
First Line	:	3874 RENEE DR
Second Line	:	UNIT F
City	:	MYRTLE BEACH
State	:	SC
Zip	:	29579-4108
Country	:	US
Telephone Number	:	843-458-3342
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/14/2006
Last Update Date	:	12/13/2007

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