Provider Demographics
NPI:1316586456
Name:EDWARDS, CANDRA NIKITA
Entity type:Individual
Prefix:
First Name:CANDRA
Middle Name:NIKITA
Last Name:EDWARDS
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 1:112 TIBURON CT
Mailing Address - Street 2:
Mailing Address - City:GOLDSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27534-7085
Mailing Address - Country:US
Mailing Address - Phone:919-988-8062
Mailing Address - Fax:919-288-1276
Practice Address - Street 1:3002 CENTRAL HEIGHTS RD
Practice Address - Street 2:
Practice Address - City:GOLDSBORO
Practice Address - State:NC
Practice Address - Zip Code:27534-7704
Practice Address - Country:US
Practice Address - Phone:919-988-8062
Practice Address - Fax:919-288-1276
Is Sole Proprietor?:Yes
Enumeration Date:2020-01-06
Last Update Date:2025-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCC0152251041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty