Provider Demographics
NPI:1588034771
Name:HALL, CANDICE MICHELLE
Entity Type:Individual
Prefix:MRS
First Name:CANDICE
Middle Name:MICHELLE
Last Name:HALL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:CANDICE
Other - Middle Name:MICHELLE
Other - Last Name:ADAMS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3018 OLD MINDEN RD STE 1104
Mailing Address - Street 2:
Mailing Address - City:BOSSIER CITY
Mailing Address - State:LA
Mailing Address - Zip Code:71112-2476
Mailing Address - Country:US
Mailing Address - Phone:318-746-1935
Mailing Address - Fax:318-658-9458
Practice Address - Street 1:3018 OLD MINDEN RD STE 1104
Practice Address - Street 2:
Practice Address - City:BOSSIER CITY
Practice Address - State:LA
Practice Address - Zip Code:71112-2476
Practice Address - Country:US
Practice Address - Phone:318-746-1935
Practice Address - Fax:318-658-9458
Is Sole Proprietor?:Yes
Enumeration Date:2015-09-30
Last Update Date:2020-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health