Provider Demographics
NPI:1437351491
Name:EVANS, CANDICE NICOLE (LCSW)
Entity Type:Individual
Prefix:
First Name:CANDICE
Middle Name:NICOLE
Last Name:EVANS
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 1:1347 S 3RD ST
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40208-3306
Mailing Address - Country:US
Mailing Address - Phone:314-583-9239
Mailing Address - Fax:
Practice Address - Street 1:1347 S 3RD ST
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40208-3306
Practice Address - Country:US
Practice Address - Phone:314-583-9239
Practice Address - Fax:314-583-9239
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-01
Last Update Date:2017-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY40881041C0700X
IN34007503A1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical