Provider Demographics
NPI:1033126081
Name:BLACK-RONEY, CANDACE DIONELLE (LPC, SOTP, SATP CSAC)
Entity Type:Individual
Prefix:
First Name:CANDACE
Middle Name:DIONELLE
Last Name:BLACK-RONEY
Suffix:
Gender:F
Credentials:LPC, SOTP, SATP CSAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19234 TURKEY EGG RD
Mailing Address - Street 2:
Mailing Address - City:DINWIDDIE
Mailing Address - State:VA
Mailing Address - Zip Code:23841-2128
Mailing Address - Country:US
Mailing Address - Phone:804-586-2503
Mailing Address - Fax:804-469-9570
Practice Address - Street 1:19234 TURKEY EGG RD
Practice Address - Street 2:
Practice Address - City:DINWIDDIE
Practice Address - State:VA
Practice Address - Zip Code:23841-2128
Practice Address - Country:US
Practice Address - Phone:804-586-2503
Practice Address - Fax:804-469-9570
Is Sole Proprietor?:No
Enumeration Date:2006-08-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0812000207101Y00000X
VA0701002775101YM0800X
VA101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101Y00000XBehavioral Health & Social Service ProvidersCounselor
Not Answered101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Not Answered101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA183170OtherSNTHEM
VA089425OtherSENTRA
VA083843OtherSENTATA
VA286047OtherANTHEM