Provider Demographics
NPI:1548942717
Name:FORD, CANDACE M (LPC-R)
Entity type:Individual
Prefix:
First Name:CANDACE
Middle Name:M
Last Name:FORD
Suffix:
Gender:F
Credentials:LPC-R
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:46 BRADBURY WAY
Mailing Address - Street 2:
Mailing Address - City:STAFFORD
Mailing Address - State:VA
Mailing Address - Zip Code:22554-1800
Mailing Address - Country:US
Mailing Address - Phone:912-484-2231
Mailing Address - Fax:
Practice Address - Street 1:46 BRADBURY WAY
Practice Address - Street 2:
Practice Address - City:STAFFORD
Practice Address - State:VA
Practice Address - Zip Code:22554-1800
Practice Address - Country:US
Practice Address - Phone:912-484-2231
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-07
Last Update Date:2023-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0704013649101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health