Provider Demographics
NPI:1154456234
Name:LADD, CANDY S (BA, MHPP)
Entity Type:Individual
Prefix:MRS
First Name:CANDY
Middle Name:S
Last Name:LADD
Suffix:
Gender:F
Credentials:BA, MHPP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:121 COMMERCIAL DR # B
Mailing Address - Street 2:
Mailing Address - City:STUTTGART
Mailing Address - State:AR
Mailing Address - Zip Code:72160-7033
Mailing Address - Country:US
Mailing Address - Phone:870-673-1633
Mailing Address - Fax:870-673-1523
Practice Address - Street 1:121 COMMERCIAL DR # B
Practice Address - Street 2:
Practice Address - City:STUTTGART
Practice Address - State:AR
Practice Address - Zip Code:72160-7033
Practice Address - Country:US
Practice Address - Phone:870-673-1633
Practice Address - Fax:870-673-1523
Is Sole Proprietor?:No
Enumeration Date:2007-02-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health