Provider Demographics
NPI:1730188277
Name:MCLEOD, CANDYCE S (NP)
Entity type:Individual
Prefix:
First Name:CANDYCE
Middle Name:S
Last Name:MCLEOD
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1624 MAIN STREET
Mailing Address - Street 2:AGAPE SENIOR PRIMARY CARE, INC., DBA LTC HEALTH SOLUTIO
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29201
Mailing Address - Country:US
Mailing Address - Phone:803-454-0365
Mailing Address - Fax:803-404-6000
Practice Address - Street 1:9302 MEDICAL PLAZA DRIVE, SUITE C
Practice Address - Street 2:LTC HEALTH SOLUTIONS
Practice Address - City:CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29406
Practice Address - Country:US
Practice Address - Phone:843-797-0416
Practice Address - Fax:843-847-4477
Is Sole Proprietor?:No
Enumeration Date:2005-07-18
Last Update Date:2015-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC45938164W00000X
SC1155363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No164W00000XNursing Service ProvidersLicensed Practical Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCNP0550Medicaid
SCSC44538753Medicare PIN
SCS88559Medicare UPIN
SC4027Medicare PIN