Provider Demographics
NPI:1467549212
Name:ROSS, CANDACE A (MSW, LCSW, MAC, CCTP)
Entity Type:Individual
Prefix:MS
First Name:CANDACE
Middle Name:A
Last Name:ROSS
Suffix:
Gender:F
Credentials:MSW, LCSW, MAC, CCTP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:238 S PENNSYLVANIA AVE UNIT 671
Mailing Address - Street 2:
Mailing Address - City:GREENSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:15601-3659
Mailing Address - Country:US
Mailing Address - Phone:412-646-6263
Mailing Address - Fax:
Practice Address - Street 1:1107 REAM AVE
Practice Address - Street 2:
Practice Address - City:MOUNT SHASTA
Practice Address - State:CA
Practice Address - Zip Code:96067-9768
Practice Address - Country:US
Practice Address - Phone:530-918-7200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-05
Last Update Date:2024-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PACW012500101YM0800X, 1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0548084Medicaid
PA173873OtherBLUE CROSS PROVIDER NUMBE