MEDICARE: CANDICE ELLIOTT

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	106S00000X	Behavior Technician	RBT-17-30749	VA
2	106E00000X	Assistant Behavior Analyst	0-21-12082

General Provider Information

NPI Number	:	1891203311
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CANDICE ELLIOTT

Provider Business Mailing Address
First Line	:	7108 S KANNER HWY
Second Line	:
City	:	STUART
State	:	FL
Zip	:	34997-7462
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	4001 VIRGINIA BEACH BLVD STE 117
Second Line	:
City	:	VIRGINIA BEACH
State	:	VA
Zip	:	23452-1759
Country	:	US
Telephone Number	:	855-832-6727
Fax Number	:

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

Provider Enumeration Date	:	01/18/2018
Last Update Date	:	05/04/2024

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Directions to “ CANDICE ELLIOTT ” Practice Location

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