Provider Demographics
NPI:1427362276
Name:NELSON, CANDACE BULLARD (MS)
Entity type:Individual
Prefix:MRS
First Name:CANDACE
Middle Name:BULLARD
Last Name:NELSON
Suffix:
Gender:F
Credentials:MS
Other - Prefix:MS
Other - First Name:CANDACE
Other - Middle Name:YVONNE
Other - Last Name:BULLARD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS
Mailing Address - Street 1:220 MAGNOLIA AVE
Mailing Address - Street 2:
Mailing Address - City:EVERGREEN
Mailing Address - State:AL
Mailing Address - Zip Code:36401-3156
Mailing Address - Country:US
Mailing Address - Phone:251-578-4545
Mailing Address - Fax:
Practice Address - Street 1:220 MAGNOLIA AVE
Practice Address - Street 2:
Practice Address - City:EVERGREEN
Practice Address - State:AL
Practice Address - Zip Code:36401-3156
Practice Address - Country:US
Practice Address - Phone:251-578-4545
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-08-04
Last Update Date:2010-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health