Provider Demographics
NPI:1477788016
Name:SMART, CANDACE (MS)
Entity Type:Individual
Prefix:
First Name:CANDACE
Middle Name:
Last Name:SMART
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:CANDACE
Other - Middle Name:
Other - Last Name:BROWN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS
Mailing Address - Street 1:5803 N ELGIN ST
Mailing Address - Street 2:
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99205-6933
Mailing Address - Country:US
Mailing Address - Phone:360-708-0977
Mailing Address - Fax:
Practice Address - Street 1:9340 NE 76TH ST
Practice Address - Street 2:
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98662-3721
Practice Address - Country:US
Practice Address - Phone:360-253-4912
Practice Address - Fax:360-253-5170
Is Sole Proprietor?:No
Enumeration Date:2009-05-27
Last Update Date:2014-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALH60043810101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health