Provider Demographics
NPI:1578389557
Name:CANDIS, KYRA M
Entity type:Individual
Prefix:
First Name:KYRA
Middle Name:M
Last Name:CANDIS
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 1:1000 COBB PLACE BLVD NW STE 230
Mailing Address - Street 2:
Mailing Address - City:KENNESAW
Mailing Address - State:GA
Mailing Address - Zip Code:30144-3684
Mailing Address - Country:US
Mailing Address - Phone:470-648-3280
Mailing Address - Fax:
Practice Address - Street 1:1000 COBB PLACE BLVD NW STE 230
Practice Address - Street 2:
Practice Address - City:KENNESAW
Practice Address - State:GA
Practice Address - Zip Code:30144-3684
Practice Address - Country:US
Practice Address - Phone:540-798-3349
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-11-25
Last Update Date:2024-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician