Provider Demographics
NPI:1518150218
Name:WEINGART, CANDACE ILENE (MA, LISAC)
Entity Type:Individual
Prefix:MS
First Name:CANDACE
Middle Name:ILENE
Last Name:WEINGART
Suffix:
Gender:F
Credentials:MA, LISAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1701 N DOUGLAS AVE
Mailing Address - Street 2:
Mailing Address - City:DOUGLAS
Mailing Address - State:AZ
Mailing Address - Zip Code:85607-1019
Mailing Address - Country:US
Mailing Address - Phone:520-364-1286
Mailing Address - Fax:520-805-1221
Practice Address - Street 1:1701 N DOUGLAS AVE
Practice Address - Street 2:
Practice Address - City:DOUGLAS
Practice Address - State:AZ
Practice Address - Zip Code:85607-1019
Practice Address - Country:US
Practice Address - Phone:520-364-1286
Practice Address - Fax:520-805-1221
Is Sole Proprietor?:No
Enumeration Date:2007-08-25
Last Update Date:2007-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLISAC 1604101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)