Provider Demographics
NPI:1215792387
Name:STINCHCOMB, CANDICE LYNNE
Entity type:Individual
Prefix:MS
First Name:CANDICE
Middle Name:LYNNE
Last Name:STINCHCOMB
Suffix:
Gender:F
Credentials:
Other - Prefix:MS
Other - First Name:CANDICE
Other - Middle Name:LYNNE
Other - Last Name:MCCLELLAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:7999 HOLTVILLE RD
Mailing Address - Street 2:
Mailing Address - City:WETUMPKA
Mailing Address - State:AL
Mailing Address - Zip Code:36092-7876
Mailing Address - Country:US
Mailing Address - Phone:334-296-8463
Mailing Address - Fax:
Practice Address - Street 1:7999 HOLTVILLE RD
Practice Address - Street 2:
Practice Address - City:WETUMPKA
Practice Address - State:AL
Practice Address - Zip Code:36092-7876
Practice Address - Country:US
Practice Address - Phone:334-296-8463
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-02-19
Last Update Date:2024-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALALCO4674101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health