Provider Demographics
NPI:1558170456
Name:GRANDERSON, CANDICE
Entity type:Individual
Prefix:
First Name:CANDICE
Middle Name:
Last Name:GRANDERSON
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 1:400 RAMSEY AVE
Mailing Address - Street 2:
Mailing Address - City:HOPEWELL
Mailing Address - State:VA
Mailing Address - Zip Code:23860-1547
Mailing Address - Country:US
Mailing Address - Phone:804-414-4351
Mailing Address - Fax:
Practice Address - Street 1:400 RAMSEY AVE
Practice Address - Street 2:
Practice Address - City:HOPEWELL
Practice Address - State:VA
Practice Address - Zip Code:23860-1547
Practice Address - Country:US
Practice Address - Phone:804-414-4351
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-01-06
Last Update Date:2025-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106E00000XBehavioral Health & Social Service ProvidersAssistant Behavior Analyst