Provider Demographics
NPI:1578527271
Name:DICKENS, CANDICE RICHARDSON (LCPC LCADC NCC MA)
Entity Type:Individual
Prefix:MS
First Name:CANDICE
Middle Name:RICHARDSON
Last Name:DICKENS
Suffix:
Gender:F
Credentials:LCPC LCADC NCC MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7859 PADDOCK WAY
Mailing Address - Street 2:
Mailing Address - City:WINDSOR MILL
Mailing Address - State:MD
Mailing Address - Zip Code:21244-1290
Mailing Address - Country:US
Mailing Address - Phone:410-744-4204
Mailing Address - Fax:410-744-4203
Practice Address - Street 1:5602 BALTIMORE NATIONAL PIKE
Practice Address - Street 2:SUITE 304
Practice Address - City:CATONSVILLE
Practice Address - State:MD-MARYLAND
Practice Address - Zip Code:21208
Practice Address - Country:UM
Practice Address - Phone:410-744-4204
Practice Address - Fax:410-744-4203
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-12
Last Update Date:2016-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLCA214101YA0400X
MDLC0686101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD3968280Medicare UPIN
MD6902000000436CMedicare UPIN
MD7234685Medicare UPIN
MD100086595001Medicare UPIN
MD364643Medicare UPIN
MD474855Medicare UPIN
MD2245173Medicare UPIN
MD2137292Medicare UPIN
DCM543001Medicare UPIN
MD789109000Medicare UPIN