Provider Demographics
NPI:1578008421
Name:BRACY, CANDACE
Entity Type:Individual
Prefix:
First Name:CANDACE
Middle Name:
Last Name:BRACY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3501 CHAMPION LAKE BLVD
Mailing Address - Street 2:APT 401
Mailing Address - City:SHREVEPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71105-3772
Mailing Address - Country:US
Mailing Address - Phone:318-655-7449
Mailing Address - Fax:
Practice Address - Street 1:3501 CHAMPION LAKE BLVD
Practice Address - Street 2:APT 401
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71105-3772
Practice Address - Country:US
Practice Address - Phone:318-655-7449
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-01-02
Last Update Date:2017-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health