Provider Demographics
NPI:1699263699
Name:LEE, CANDIS (CMHT)
Entity type:Individual
Prefix:MRS
First Name:CANDIS
Middle Name:
Last Name:LEE
Suffix:
Gender:F
Credentials:CMHT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1989 PASS RD
Mailing Address - Street 2:
Mailing Address - City:BILOXI
Mailing Address - State:MS
Mailing Address - Zip Code:39531-4103
Mailing Address - Country:US
Mailing Address - Phone:228-207-1248
Mailing Address - Fax:
Practice Address - Street 1:1989 PASS RD
Practice Address - Street 2:
Practice Address - City:BILOXI
Practice Address - State:MS
Practice Address - Zip Code:39531-4103
Practice Address - Country:US
Practice Address - Phone:228-207-1248
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-04-25
Last Update Date:2018-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health