Provider Demographics
NPI:1962063636
Name:TATE, CANDICE NICOLE (LPN)
Entity type:Individual
Prefix:
First Name:CANDICE
Middle Name:NICOLE
Last Name:TATE
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13308 MOSS POINT DR APT A
Mailing Address - Street 2:
Mailing Address - City:HAMMOND
Mailing Address - State:LA
Mailing Address - Zip Code:70401-6448
Mailing Address - Country:US
Mailing Address - Phone:985-215-1365
Mailing Address - Fax:
Practice Address - Street 1:44617 S AIRPORT RD
Practice Address - Street 2:
Practice Address - City:HAMMOND
Practice Address - State:LA
Practice Address - Zip Code:70403-0311
Practice Address - Country:US
Practice Address - Phone:985-429-7611
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-06-24
Last Update Date:2019-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No171M00000XOther Service ProvidersCase Manager/Care Coordinator