Provider Demographics
NPI:1518654466
Name:VIVAS, CANDACE ROSE (MAC, LPCA)
Entity Type:Individual
Prefix:
First Name:CANDACE
Middle Name:ROSE
Last Name:VIVAS
Suffix:
Gender:F
Credentials:MAC, LPCA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5510 GLENCREE CT
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27612-8707
Mailing Address - Country:US
Mailing Address - Phone:919-861-7435
Mailing Address - Fax:877-920-1934
Practice Address - Street 1:12339 WAKE UNION CHURCH RD STE 111
Practice Address - Street 2:
Practice Address - City:WAKE FOREST
Practice Address - State:NC
Practice Address - Zip Code:27587-4512
Practice Address - Country:US
Practice Address - Phone:919-867-0360
Practice Address - Fax:877-920-1934
Is Sole Proprietor?:Yes
Enumeration Date:2023-04-20
Last Update Date:2023-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC8425101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional