Provider Demographics
NPI:1992993364
Name:KINGREY, CANDICE (MS)
Entity type:Individual
Prefix:
First Name:CANDICE
Middle Name:
Last Name:KINGREY
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:CANDICE
Other - Middle Name:
Other - Last Name:BURKE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CANDICE BURKE
Mailing Address - Street 1:1307 S HAMILTON RD
Mailing Address - Street 2:
Mailing Address - City:MOSES LAKE
Mailing Address - State:WA
Mailing Address - Zip Code:98837-9791
Mailing Address - Country:US
Mailing Address - Phone:360-949-5245
Mailing Address - Fax:
Practice Address - Street 1:605 S COOLIDGE ST
Practice Address - Street 2:
Practice Address - City:MOSES LAKE
Practice Address - State:WA
Practice Address - Zip Code:98837-1873
Practice Address - Country:US
Practice Address - Phone:509-765-0674
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-10-10
Last Update Date:2023-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALH61018883101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health