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NPI Code Detail

MEDICARE: CANDICE BRENNEMAN M.S., LMFT

MEDICARE: CANDICE BRENNEMAN M.S., LMFT
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
1106H00000XMarriage & Family Therapist1368NC

General Provider Information

NPI Number : 1619119674
Entity Type Code : Individual
Provider Name (Legal Business Name) : CANDICE BRENNEMAN M.S., LMFT
Provider Business Mailing Address
First Line : 3909 PALLAS WAY APT 1H
Second Line :
City : HIGH POINT
State : NC
Zip : 27265-3629
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 3909 PALLAS WAY APT 1H
Second Line :
City : HIGH POINT
State : NC
Zip : 27265-3629
Country : US
Telephone Number : 336-880-2643
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/06/2009
Last Update Date : 05/04/2012

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