Provider Demographics
NPI:1528431814
Name:CLARK, CANDICE (LCSWA)
Entity type:Individual
Prefix:
First Name:CANDICE
Middle Name:
Last Name:CLARK
Suffix:
Gender:F
Credentials:LCSWA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:405 BIGGS ST
Mailing Address - Street 2:
Mailing Address - City:LAURINBURG
Mailing Address - State:NC
Mailing Address - Zip Code:28352-4109
Mailing Address - Country:US
Mailing Address - Phone:191-061-0444
Mailing Address - Fax:910-610-4434
Practice Address - Street 1:405 BIGGS ST
Practice Address - Street 2:
Practice Address - City:LAURINBURG
Practice Address - State:NC
Practice Address - Zip Code:28352-4109
Practice Address - Country:US
Practice Address - Phone:191-061-0444
Practice Address - Fax:910-610-4434
Is Sole Proprietor?:Yes
Enumeration Date:2015-11-09
Last Update Date:2015-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCP0101801041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical