Provider Demographics
NPI:1528589330
Name:JOHNSON, CANDACE NICHOLE (MS,NCC,LPC)
Entity Type:Individual
Prefix:MRS
First Name:CANDACE
Middle Name:NICHOLE
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:MS,NCC,LPC
Other - Prefix:
Other - First Name:CANDACE
Other - Middle Name:NICHOLE
Other - Last Name:SMITH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS
Mailing Address - Street 1:4512 BOLTON NOTCH PL
Mailing Address - Street 2:
Mailing Address - City:HARRISBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17110-3414
Mailing Address - Country:US
Mailing Address - Phone:412-708-7482
Mailing Address - Fax:717-796-5246
Practice Address - Street 1:121 LOCUST ST
Practice Address - Street 2:
Practice Address - City:HARRISBURG
Practice Address - State:PA
Practice Address - Zip Code:17101-1411
Practice Address - Country:US
Practice Address - Phone:717-238-8118
Practice Address - Fax:717-238-8140
Is Sole Proprietor?:No
Enumeration Date:2017-06-30
Last Update Date:2017-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPC009717101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional