Provider Demographics
NPI:1033395512
Name:BLACKWOOD, CANDACE ALEXIS (MS)
Entity Type:Individual
Prefix:MRS
First Name:CANDACE
Middle Name:ALEXIS
Last Name:BLACKWOOD
Suffix:
Gender:F
Credentials:MS
Other - Prefix:MISS
Other - First Name:CANDACE
Other - Middle Name:ALEXIS
Other - Last Name:HAYES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS
Mailing Address - Street 1:1825 MARIKA RD
Mailing Address - Street 2:
Mailing Address - City:FAIRBANKS
Mailing Address - State:AK
Mailing Address - Zip Code:99709-5521
Mailing Address - Country:US
Mailing Address - Phone:907-474-0890
Mailing Address - Fax:907-451-8945
Practice Address - Street 1:1825 MARIKA RD
Practice Address - Street 2:
Practice Address - City:FAIRBANKS
Practice Address - State:AK
Practice Address - Zip Code:99709-5521
Practice Address - Country:US
Practice Address - Phone:907-474-0890
Practice Address - Fax:907-451-8945
Is Sole Proprietor?:No
Enumeration Date:2008-01-15
Last Update Date:2008-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health