Provider Demographics
NPI:1295866887
Name:SOTRIFFER, CANDICE RAE (MA EDS LPC)
Entity Type:Individual
Prefix:MS
First Name:CANDICE
Middle Name:RAE
Last Name:SOTRIFFER
Suffix:
Gender:F
Credentials:MA EDS LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:898 NIFONG RD
Mailing Address - Street 2:
Mailing Address - City:CLEMMONS
Mailing Address - State:NC
Mailing Address - Zip Code:27012-6930
Mailing Address - Country:US
Mailing Address - Phone:336-764-2865
Mailing Address - Fax:
Practice Address - Street 1:1365 WESTGATE CENTER DR
Practice Address - Street 2:SUITE A-2
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27103-2980
Practice Address - Country:US
Practice Address - Phone:336-416-0016
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5563101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional