Provider Demographics
NPI:1629762273
Name:BROWN, CANDACE RAQUEL-CHRISTEN (LCSW)
Entity type:Individual
Prefix:MISS
First Name:CANDACE
Middle Name:RAQUEL-CHRISTEN
Last Name:BROWN
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:801 N HANLEY RD APT D
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63130-2828
Mailing Address - Country:US
Mailing Address - Phone:314-971-9118
Mailing Address - Fax:
Practice Address - Street 1:12355 DE PAUL DR STE 150
Practice Address - Street 2:
Practice Address - City:BRIDGETON
Practice Address - State:MO
Practice Address - Zip Code:63044-2581
Practice Address - Country:US
Practice Address - Phone:314-344-7153
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-06-06
Last Update Date:2024-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2021044523104100000X
MO20240183961041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker