Provider Demographics
NPI:1558123521
Name:MIMES, CANDICE MARIE (MSW, CSW)
Entity Type:Individual
Prefix:MS
First Name:CANDICE
Middle Name:MARIE
Last Name:MIMES
Suffix:
Gender:F
Credentials:MSW, CSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2500 ALUMNI DR APT 2104
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40517-3967
Mailing Address - Country:US
Mailing Address - Phone:859-351-2311
Mailing Address - Fax:
Practice Address - Street 1:501 DARBY CREEK RD STE 62
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40509-2611
Practice Address - Country:US
Practice Address - Phone:859-303-8006
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-01-25
Last Update Date:2024-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY255533104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker