Provider Demographics
NPI:1902287576
Name:LOPEZ, CANDACE KAY (LMSW)
Entity Type:Individual
Prefix:MRS
First Name:CANDACE
Middle Name:KAY
Last Name:LOPEZ
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:MS
Other - First Name:CANDACE
Other - Middle Name:KAY
Other - Last Name:CAIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMSW
Mailing Address - Street 1:PO BOX 457
Mailing Address - Street 2:
Mailing Address - City:GANADO
Mailing Address - State:AZ
Mailing Address - Zip Code:86505-0457
Mailing Address - Country:US
Mailing Address - Phone:928-755-4500
Mailing Address - Fax:928-755-4659
Practice Address - Street 1:ARIZONA HIGHWAY 264 & HIGHWAY 191
Practice Address - Street 2:
Practice Address - City:GANADO
Practice Address - State:AZ
Practice Address - Zip Code:86505-0457
Practice Address - Country:US
Practice Address - Phone:928-755-4500
Practice Address - Fax:928-755-4659
Is Sole Proprietor?:Yes
Enumeration Date:2015-06-09
Last Update Date:2015-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLMSW-139011041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical