Provider Demographics
NPI:1174650899
Name:MERRITT, CANDACE DAWN (LCSW, LAC)
Entity Type:Individual
Prefix:MS
First Name:CANDACE
Middle Name:DAWN
Last Name:MERRITT
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:CMR 454,BOX 3178
Mailing Address - Street 2:USAG ANSBACH-ASAP
Mailing Address - City:APO
Mailing Address - State:AE
Mailing Address - Zip Code:09250
Mailing Address - Country:US
Mailing Address - Phone:0049171-943-4672
Mailing Address - Fax:
Practice Address - Street 1:CMR 454 BOX 3178
Practice Address - Street 2:CMR 454 BOX 3178
Practice Address - City:APO
Practice Address - State:AE
Practice Address - Zip Code:09250
Practice Address - Country:US
Practice Address - Phone:0049171-943-4672
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-28
Last Update Date:2008-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO110101YA0400X
CO9928161041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)