Provider Demographics
NPI:1891685392
Name:STREETER, CANDACE
Entity type:Individual
Prefix:
First Name:CANDACE
Middle Name:
Last Name:STREETER
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 1:13 AVERY PL
Mailing Address - Street 2:
Mailing Address - City:FORT MITCHELL
Mailing Address - State:AL
Mailing Address - Zip Code:36856-5161
Mailing Address - Country:US
Mailing Address - Phone:334-650-5673
Mailing Address - Fax:
Practice Address - Street 1:3021 WILLIAMS RD
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:GA
Practice Address - Zip Code:31909-1101
Practice Address - Country:US
Practice Address - Phone:888-963-2228
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-07-07
Last Update Date:2025-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALRBT-25-450800106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician