Provider Demographics
NPI:1316397151
Name:GARRISON, CANDACE NAOMI (BS)
Entity Type:Individual
Prefix:MRS
First Name:CANDACE
Middle Name:NAOMI
Last Name:GARRISON
Suffix:
Gender:F
Credentials:BS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2711 ERNEST ST
Mailing Address - Street 2:
Mailing Address - City:LAKE CHARLES
Mailing Address - State:LA
Mailing Address - Zip Code:70601-8406
Mailing Address - Country:US
Mailing Address - Phone:337-431-7194
Mailing Address - Fax:337-431-7198
Practice Address - Street 1:2711 ERNEST ST
Practice Address - Street 2:
Practice Address - City:LAKE CHARLES
Practice Address - State:LA
Practice Address - Zip Code:70601-8406
Practice Address - Country:US
Practice Address - Phone:337-431-7194
Practice Address - Fax:337-431-7198
Is Sole Proprietor?:No
Enumeration Date:2016-06-13
Last Update Date:2016-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1649929Medicaid