Provider Demographics
NPI:1861949893
Name:POITRAS, CANDRA JAMAE (MAC)
Entity type:Individual
Prefix:MISS
First Name:CANDRA
Middle Name:JAMAE
Last Name:POITRAS
Suffix:
Gender:F
Credentials:MAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:921 TIMBERWOOD CROSSING CT
Mailing Address - Street 2:
Mailing Address - City:FLORISSANT
Mailing Address - State:MO
Mailing Address - Zip Code:63031-7518
Mailing Address - Country:US
Mailing Address - Phone:314-803-0280
Mailing Address - Fax:
Practice Address - Street 1:567 MADISON ST
Practice Address - Street 2:
Practice Address - City:SAINT CHARLES
Practice Address - State:MO
Practice Address - Zip Code:63301-2747
Practice Address - Country:US
Practice Address - Phone:636-699-0872
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-09-07
Last Update Date:2016-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101Y00000XBehavioral Health & Social Service ProvidersCounselor