MEDICARE: CANDICE A MCCALLIE B.S.

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	101YM0800X	Mental Health Counselor

General Provider Information

NPI Number	:	1396909560
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CANDICE A MCCALLIE B.S.

Provider Business Mailing Address
First Line	:	8 COSMIC WAY
Second Line	:
City	:	LOOKOUT MOUNTAIN
State	:	GA
Zip	:	30750-4750
Country	:	US
Telephone Number	:	423-756-2740
Fax Number	:

Provider Business Practice Location Address
First Line	:	8 COSMIC WAY
Second Line	:
City	:	LOOKOUT MOUNTAIN
State	:	GA
Zip	:	30750-4750
Country	:	US
Telephone Number	:	423-756-2740
Fax Number	:

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

Provider Enumeration Date	:	07/16/2008
Last Update Date	:	07/16/2008

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