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NPI Code Detail

MEDICARE: CANDICE POLK

MEDICARE: CANDICE POLK
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
1106S00000XBehavior Technician

General Provider Information

NPI Number : 1942135264
Entity Type Code : Individual
Provider Name (Legal Business Name) : CANDICE POLK
Provider Business Mailing Address
First Line : 1407 WHITBY MOORE ST APT 302
Second Line :
City : CHARLOTTE
State : NC
Zip : 28273-5878
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 2301 CROWNPOINT EXECUTIVE DR UNIT J
Second Line :
City : CHARLOTTE
State : NC
Zip : 28227-7824
Country : US
Telephone Number : 704-619-7060
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/17/2026
Last Update Date : 06/17/2026

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Directions to “ CANDICE POLK ” Practice Location

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