Provider Demographics
NPI:1437901691
Name:DICK, CANDACE (CPSS, CSA)
Entity Type:Individual
Prefix:
First Name:CANDACE
Middle Name:
Last Name:DICK
Suffix:
Gender:F
Credentials:CPSS, CSA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:510 E HIGHWAY 635
Mailing Address - Street 2:
Mailing Address - City:SCIENCE HILL
Mailing Address - State:KY
Mailing Address - Zip Code:42553-9403
Mailing Address - Country:US
Mailing Address - Phone:606-425-0255
Mailing Address - Fax:
Practice Address - Street 1:233 PARKERS MILL WAY
Practice Address - Street 2:
Practice Address - City:SOMERSET
Practice Address - State:KY
Practice Address - Zip Code:42503-4152
Practice Address - Country:US
Practice Address - Phone:606-425-0255
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-04-02
Last Update Date:2024-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY175T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist