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Individual

CANDICE VIDA COULTER

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
LPC, NCC

Contact information

Practice address
9929 REA RD, STE 201, WAXHAW, NC 28173
(704) 316-1650
(704) 316-1651
Mailing address
PO BOX 60447, CHARLOTTE, NC 28260-0447
(704) 316-1650
(704) 316-1651

Taxonomy

Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
Primary
11636
NC

Other

Enumeration date
03/04/2019
Last updated
10/26/2020
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