Provider Demographics
NPI:1861680043
Name:CONNER, CANDYCE V (MS, LPC)
Entity type:Individual
Prefix:MS
First Name:CANDYCE
Middle Name:V
Last Name:CONNER
Suffix:
Gender:F
Credentials:MS, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 37492
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23234-7492
Mailing Address - Country:US
Mailing Address - Phone:804-502-9847
Mailing Address - Fax:804-743-0084
Practice Address - Street 1:6601 PHILBROOK RD
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23234-6228
Practice Address - Country:US
Practice Address - Phone:804-502-9847
Practice Address - Fax:804-743-0084
Is Sole Proprietor?:No
Enumeration Date:2007-10-12
Last Update Date:2007-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0701004235101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional