Provider Demographics
NPI:1386861060
Name:EDDY, CANDACE KIMBERLY (MSW, LCSW)
Entity Type:Individual
Prefix:MS
First Name:CANDACE
Middle Name:KIMBERLY
Last Name:EDDY
Suffix:
Gender:F
Credentials:MSW, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2424
Mailing Address - Street 2:
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89505-2424
Mailing Address - Country:US
Mailing Address - Phone:775-287-3196
Mailing Address - Fax:775-284-4595
Practice Address - Street 1:650 EDISON WAY
Practice Address - Street 2:
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89502-4100
Practice Address - Country:US
Practice Address - Phone:775-284-4717
Practice Address - Fax:775-284-4595
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-20
Last Update Date:2010-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV5685-C1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical