Provider Demographics
NPI:1447630330
Name:KIMBROUGH, CANDACE MCWHIRTER (LPC, LCDC)
Entity type:Individual
Prefix:MRS
First Name:CANDACE
Middle Name:MCWHIRTER
Last Name:KIMBROUGH
Suffix:
Gender:F
Credentials:LPC, LCDC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12600 SCHREINER CT
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78732-2245
Mailing Address - Country:US
Mailing Address - Phone:404-583-6540
Mailing Address - Fax:
Practice Address - Street 1:12600 SCHREINER CT
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78732-2245
Practice Address - Country:US
Practice Address - Phone:404-583-6540
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-06-04
Last Update Date:2015-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX20972101YA0400X
TX71470101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)