Provider Demographics
NPI:1285690206
Name:SMITH, CANDACE MARIE (MS)
Entity Type:Individual
Prefix:MRS
First Name:CANDACE
Middle Name:MARIE
Last Name:SMITH
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:213 COLLEGE STREET
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29601
Mailing Address - Country:US
Mailing Address - Phone:864-235-6011
Mailing Address - Fax:864-272-0091
Practice Address - Street 1:213 COLLEGE STREET
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29601
Practice Address - Country:US
Practice Address - Phone:864-235-6011
Practice Address - Fax:864-272-0091
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC2954101Y00000X
SCT822225800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101Y00000XBehavioral Health & Social Service ProvidersCounselor
Not Answered225800000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRecreation Therapist