Provider Demographics
NPI:1376089532
Name:HANSON, CANDACE LATANYA (MA, LPCC)
Entity Type:Individual
Prefix:MRS
First Name:CANDACE
Middle Name:LATANYA
Last Name:HANSON
Suffix:
Gender:F
Credentials:MA, LPCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1831 PENNSYLVANIA AVE S
Mailing Address - Street 2:
Mailing Address - City:ST LOUIS PARK
Mailing Address - State:MN
Mailing Address - Zip Code:55426-2042
Mailing Address - Country:US
Mailing Address - Phone:918-770-1672
Mailing Address - Fax:
Practice Address - Street 1:109 N SHORE DR
Practice Address - Street 2:
Practice Address - City:WAVERLY
Practice Address - State:MN
Practice Address - Zip Code:55390-5517
Practice Address - Country:US
Practice Address - Phone:763-658-5810
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-01-12
Last Update Date:2017-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN1212101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional