Provider Demographics
NPI:1427634328
Name:MOYER, CANDI ANN
Entity type:Individual
Prefix:
First Name:CANDI
Middle Name:ANN
Last Name:MOYER
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 1:29 RIPPON AVE
Mailing Address - Street 2:
Mailing Address - City:HILLSDALE
Mailing Address - State:MI
Mailing Address - Zip Code:49242-1514
Mailing Address - Country:US
Mailing Address - Phone:517-610-3461
Mailing Address - Fax:
Practice Address - Street 1:200 VISTA DR
Practice Address - Street 2:
Practice Address - City:COLDWATER
Practice Address - State:MI
Practice Address - Zip Code:49036-1776
Practice Address - Country:US
Practice Address - Phone:517-278-2129
Practice Address - Fax:517-279-8172
Is Sole Proprietor?:No
Enumeration Date:2021-03-22
Last Update Date:2021-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68011092361041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical