Provider Demographics
NPI:1376832378
Name:CREEL, CANDACE P (LISW-CP)
Entity Type:Individual
Prefix:MRS
First Name:CANDACE
Middle Name:P
Last Name:CREEL
Suffix:
Gender:F
Credentials:LISW-CP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:151 GAVINS RD
Mailing Address - Street 2:
Mailing Address - City:HARLEYVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29448-3745
Mailing Address - Country:US
Mailing Address - Phone:843-297-0091
Mailing Address - Fax:
Practice Address - Street 1:222 VARNFIELD DR STE A
Practice Address - Street 2:
Practice Address - City:SUMMERVILLE
Practice Address - State:SC
Practice Address - Zip Code:29483-7345
Practice Address - Country:US
Practice Address - Phone:843-297-0091
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-03-31
Last Update Date:2017-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC51801041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCSW1169Medicaid