Provider Demographics
NPI:1508909755
Name:VARVIL, CANDACE (PHD)
Entity Type:Individual
Prefix:
First Name:CANDACE
Middle Name:
Last Name:VARVIL
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:144 BREWER DR
Mailing Address - Street 2:
Mailing Address - City:MARQUETTE
Mailing Address - State:MI
Mailing Address - Zip Code:49855-9588
Mailing Address - Country:US
Mailing Address - Phone:906-249-5165
Mailing Address - Fax:
Practice Address - Street 1:104 E WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:MARQUETTE
Practice Address - State:MI
Practice Address - Zip Code:49855-4318
Practice Address - Country:US
Practice Address - Phone:906-228-3092
Practice Address - Fax:906-228-3092
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301002701103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI680E24541OtherBCBS