| Doctor Name: | KANDACE KONOLA |
| NPI Number: | 1487013405 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | |
| License Number: | BBH-LCPC-LIC-16222 |
| Business Practice Address: | 205 E Park Ave Anaconda, MT - 597112340 |
| Business Phone Number: | 4065638117 |
| Business Fax Number: | 4065635956 |
| Mailing Address: | 205 E Park Ave, ANACONDA |
| State: | MT |
| Postal Code: | 597112340 |
| Phone Number: | 4065638117 |
| Fax Number: | 4065635956 |
| NPI Enumeration Date: | 02/18/2016 |
| NPI Last Update Date: | 02/18/2016 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101YM0800X |
| License Number: | BBH-LCPC-LIC-16222 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | MT |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Counselor |
| Taxonomy Specialization: | Mental Health |
| Taxonomy Definition: | |