Provider Demographics
NPI:1932367216
Name:DR CANDACE MARTIN
Entity type:Organization
Organization Name:DR CANDACE MARTIN
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:CANDACE
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:MARTIN
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:972-780-5160
Mailing Address - Street 1:1801 N HAMPTON RD
Mailing Address - Street 2:SUITE 410
Mailing Address - City:DESOTO
Mailing Address - State:TX
Mailing Address - Zip Code:75115-8317
Mailing Address - Country:US
Mailing Address - Phone:972-780-5160
Mailing Address - Fax:972-780-5735
Practice Address - Street 1:1801 N HAMPTON RD
Practice Address - Street 2:SUITE 410
Practice Address - City:DESOTO
Practice Address - State:TX
Practice Address - Zip Code:75115-8317
Practice Address - Country:US
Practice Address - Phone:972-780-5160
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-23
Last Update Date:2008-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty