Provider Demographics
NPI:1043085798
Name:BEASLEY, CANDICE C (MSW, DSW, LCSW-BACS)
Entity Type:Individual
Prefix:
First Name:CANDICE
Middle Name:C
Last Name:BEASLEY
Suffix:
Gender:F
Credentials:MSW, DSW, LCSW-BACS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4220 LASALLE ST
Mailing Address - Street 2:
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70115-6248
Mailing Address - Country:US
Mailing Address - Phone:504-258-1139
Mailing Address - Fax:
Practice Address - Street 1:4220 LASALLE ST
Practice Address - Street 2:
Practice Address - City:NEW ORLEANS
Practice Address - State:LA
Practice Address - Zip Code:70115-6248
Practice Address - Country:US
Practice Address - Phone:504-258-1139
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-11-21
Last Update Date:2023-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA114751041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty