Provider Demographics
NPI:1326402439
Name:RIDDLEY, CANDACE LASHELL (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:CANDACE
Middle Name:LASHELL
Last Name:RIDDLEY
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:122 OAKLEIGH DR
Mailing Address - Street 2:
Mailing Address - City:CLINTON
Mailing Address - State:MS
Mailing Address - Zip Code:39056-6038
Mailing Address - Country:US
Mailing Address - Phone:601-955-2709
Mailing Address - Fax:
Practice Address - Street 1:122 OAKLEIGH DR
Practice Address - Street 2:
Practice Address - City:CLINTON
Practice Address - State:MS
Practice Address - Zip Code:39056-6038
Practice Address - Country:US
Practice Address - Phone:601-955-2709
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-04-06
Last Update Date:2016-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSC79601041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical