Candice Yvonne Gore, LCAS

Primary specialty

Addiction (Substance Use Disorder) CounselorTaxonomy code 101YA0400X

License

1759 Issued in NC

Practice address

1606 Wellington Ave Unit C
Community Support Professionals,LLC
Wilmington, NC 28401-7704

Phone

(910) 799-4505

Fax

(910) 799-4345

NPI assigned

Sep 18, 2009

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Other identifiers 1

Other names 1

• Candice Yvonne Glover Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1253232000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1365552000000",
    "number": "1750614079",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4321 TILLSON ROAD",
            "city": "WILMINGTON",
            "state": "NC",
            "postal_code": "28412",
            "telephone_number": "770-722-4882"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1606 WELLINGTON AVE UNIT C",
            "address_2": "COMMUNITY SUPPORT PROFESSIONALS,LLC",
            "city": "WILMINGTON",
            "state": "NC",
            "postal_code": "284017704",
            "telephone_number": "910-799-4505",
            "fax_number": "910-799-4345"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GORE",
        "first_name": "CANDICE",
        "middle_name": "YVONNE",
        "credential": "LCAS",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2009-09-18",
        "last_updated": "2013-04-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "NC",
            "license": "1759",
            "primary": true
        },
        {
            "code": "106H00000X",
            "taxonomy_group": "",
            "desc": "Marriage & Family Therapist",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NORTH CAROLINA SUBSTANCE ABUSE PRACTICE BOARD",
            "identifier": "1759",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "CANDICE",
            "last_name": "GLOVER",
            "middle_name": "YVONNE",
            "credential": "LCAS",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Diana Gorder, DPT
• Kevin Gorder, DPT
• Kelly Gordon-Wylie, LCSW-A
• Rebecca Anne Gordon, PT
• Sarah Makenzie Gordon, DO
• Jasmin Gore
• Sallie Gore
• William Gore, PA
• Sudie Brown Gorges
• Robert Gorlach, LCSW

• Addiction (Substance Use Disorder) Counselor in Wilmington, NC
• Providers in Wilmington, NC by specialty
• Addiction (Substance Use Disorder) Counselor in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 10, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.