Provider Demographics
NPI:1003410986
Name:DRYDEN, CANDICE (CSW)
Entity Type:Individual
Prefix:MRS
First Name:CANDICE
Middle Name:
Last Name:DRYDEN
Suffix:
Gender:F
Credentials:CSW
Other - Prefix:
Other - First Name:CANDICE
Other - Middle Name:
Other - Last Name:COUVILLION
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CSW
Mailing Address - Street 1:7719 HICKORY GROVE LOOP
Mailing Address - Street 2:
Mailing Address - City:DEVILLE
Mailing Address - State:LA
Mailing Address - Zip Code:71328-8212
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:457 2ND ST
Practice Address - Street 2:
Practice Address - City:COLFAX
Practice Address - State:LA
Practice Address - Zip Code:71417-1807
Practice Address - Country:US
Practice Address - Phone:318-827-4357
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-23
Last Update Date:2020-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA15250101YM0800X, 104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health