Provider Demographics
NPI:1427485309
Name:CANDIS COUNSELING & THERAPEUTIC SERVICES LLC
Entity type:Organization
Organization Name:CANDIS COUNSELING & THERAPEUTIC SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/LICENSED THERAPIST
Authorized Official - Prefix:MR
Authorized Official - First Name:LAVASAOUS
Authorized Official - Middle Name:A
Authorized Official - Last Name:CANDIS
Authorized Official - Suffix:
Authorized Official - Credentials:LMHC, CAP
Authorized Official - Phone:813-754-1739
Mailing Address - Street 1:1103 N WHEELER ST STE C
Mailing Address - Street 2:
Mailing Address - City:PLANT CITY
Mailing Address - State:FL
Mailing Address - Zip Code:33563-3112
Mailing Address - Country:US
Mailing Address - Phone:813-754-1739
Mailing Address - Fax:813-659-1292
Practice Address - Street 1:1103 N WHEELER ST STE C
Practice Address - Street 2:
Practice Address - City:PLANT CITY
Practice Address - State:FL
Practice Address - Zip Code:33563-3112
Practice Address - Country:US
Practice Address - Phone:813-754-1739
Practice Address - Fax:813-659-1292
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-10-09
Last Update Date:2013-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11677251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health