Provider Demographics
NPI:1356910434
Name:HARLESS, CANDACE RENEE (QMHP TRAINEE)
Entity type:Individual
Prefix:
First Name:CANDACE
Middle Name:RENEE
Last Name:HARLESS
Suffix:
Gender:F
Credentials:QMHP TRAINEE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 ARBOR DR STE 105
Mailing Address - Street 2:
Mailing Address - City:CHRISTIANSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:24073-6585
Mailing Address - Country:US
Mailing Address - Phone:540-688-6813
Mailing Address - Fax:
Practice Address - Street 1:100 ARBOR DR STE 105
Practice Address - Street 2:
Practice Address - City:CHRISTIANSBURG
Practice Address - State:VA
Practice Address - Zip Code:24073-6585
Practice Address - Country:US
Practice Address - Phone:540-688-6813
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-06-22
Last Update Date:2024-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program