Provider Demographics
NPI:1285161471
Name:MORRIS, CANDACE R
Entity type:Individual
Prefix:
First Name:CANDACE
Middle Name:R
Last Name:MORRIS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:301 N HERMAN ST BOX CC
Mailing Address - Street 2:APT F3
Mailing Address - City:GOLDSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27530
Mailing Address - Country:US
Mailing Address - Phone:919-731-1280
Mailing Address - Fax:
Practice Address - Street 1:301 N HERMAN ST STE CC
Practice Address - Street 2:
Practice Address - City:GOLDSBORO
Practice Address - State:NC
Practice Address - Zip Code:27530-2971
Practice Address - Country:US
Practice Address - Phone:919-731-1280
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-05-18
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC86043371133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered