Provider Demographics
NPI:1134659956
Name:BLOOD, CANDACE LYNNE (LCSW, LAC)
Entity Type:Individual
Prefix:MS
First Name:CANDACE
Middle Name:LYNNE
Last Name:BLOOD
Suffix:
Gender:F
Credentials:LCSW, LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 HILTON CT
Mailing Address - Street 2:
Mailing Address - City:PINEVILLE
Mailing Address - State:LA
Mailing Address - Zip Code:71360-5673
Mailing Address - Country:US
Mailing Address - Phone:318-403-1557
Mailing Address - Fax:
Practice Address - Street 1:5505 JOHN ESKEW DR
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:LA
Practice Address - Zip Code:71303-3725
Practice Address - Country:US
Practice Address - Phone:318-403-1557
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-06-14
Last Update Date:2017-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA1446101YA0400X
LA124751041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)