Provider Demographics
NPI:1386451748
Name:LEONG, CANDACE MCGALLIARD (LAPC)
Entity type:Individual
Prefix:MRS
First Name:CANDACE
Middle Name:MCGALLIARD
Last Name:LEONG
Suffix:
Gender:F
Credentials:LAPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:241 WATERFORD DR STE 500
Mailing Address - Street 2:
Mailing Address - City:BONAIRE
Mailing Address - State:GA
Mailing Address - Zip Code:31005-3621
Mailing Address - Country:US
Mailing Address - Phone:478-230-2974
Mailing Address - Fax:
Practice Address - Street 1:104 BORDERS WAY
Practice Address - Street 2:
Practice Address - City:WARNER ROBINS
Practice Address - State:GA
Practice Address - Zip Code:31088-8966
Practice Address - Country:US
Practice Address - Phone:478-333-2182
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-12-18
Last Update Date:2024-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAAPC010050101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health