Provider Demographics
NPI:1538352166
Name:TOLBERT, CANDIA ALEA
Entity type:Individual
Prefix:MRS
First Name:CANDIA
Middle Name:ALEA
Last Name:TOLBERT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:CANDIA
Other - Middle Name:ALEA
Other - Last Name:LANGHANS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LSW, CEP
Mailing Address - Street 1:895 ROBERTA LANE, SUITE 101
Mailing Address - Street 2:
Mailing Address - City:SPARKS
Mailing Address - State:NV
Mailing Address - Zip Code:89431-6810
Mailing Address - Country:US
Mailing Address - Phone:775-331-6252
Mailing Address - Fax:775-331-6250
Practice Address - Street 1:895 ROBERTA LN STE 101
Practice Address - Street 2:
Practice Address - City:SPARKS
Practice Address - State:NV
Practice Address - Zip Code:89431-6802
Practice Address - Country:US
Practice Address - Phone:775-331-6252
Practice Address - Fax:775-331-6250
Is Sole Proprietor?:No
Enumeration Date:2007-08-27
Last Update Date:2011-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
103K00000X, 101YS0200X
NV4121-S104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No101YS0200XBehavioral Health & Social Service ProvidersCounselorSchool
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV08272007792108Medicaid