Provider Demographics
NPI:1215229422
Name:WALL, CANDACE
Entity Type:Individual
Prefix:
First Name:CANDACE
Middle Name:
Last Name:WALL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:60 ROBERTS DR STE 215
Mailing Address - Street 2:
Mailing Address - City:NORTH ADAMS
Mailing Address - State:MA
Mailing Address - Zip Code:01247-3256
Mailing Address - Country:US
Mailing Address - Phone:413-353-2515
Mailing Address - Fax:888-350-9913
Practice Address - Street 1:60 ROBERTS DR STE 215
Practice Address - Street 2:
Practice Address - City:NORTH ADAMS
Practice Address - State:MA
Practice Address - Zip Code:01247-3256
Practice Address - Country:US
Practice Address - Phone:413-353-2515
Practice Address - Fax:888-350-9913
Is Sole Proprietor?:Yes
Enumeration Date:2011-05-05
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor