Provider Demographics
NPI:1427040740
Name:CAMPBELL, CANDESS MARIE (MA)
Entity Type:Individual
Prefix:MS
First Name:CANDESS
Middle Name:MARIE
Last Name:CAMPBELL
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2317 W CLARKE AVE
Mailing Address - Street 2:
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99201-1408
Mailing Address - Country:US
Mailing Address - Phone:509-363-1789
Mailing Address - Fax:509-363-1789
Practice Address - Street 1:2317 W CLARKE AVE
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99201-1408
Practice Address - Country:US
Practice Address - Phone:509-363-1789
Practice Address - Fax:509-363-1789
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-08-22
Last Update Date:2007-07-08
Deactivation Date:2006-03-27
Deactivation Code:
Reactivation Date:2006-03-31
Provider Licenses
StateLicense IDTaxonomies
WACDP 00001122101YA0400X
WALH00004496101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Not Answered101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health