Provider Demographics
NPI:1598081887
Name:COX, CANDICE EVETTA (LCSW)
Entity Type:Individual
Prefix:
First Name:CANDICE
Middle Name:EVETTA
Last Name:COX
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8790 MANCHESTER RD STE 205A
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63144-2707
Mailing Address - Country:US
Mailing Address - Phone:314-898-6541
Mailing Address - Fax:314-558-8448
Practice Address - Street 1:8790 MANCHESTER RD STE 205A
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63144-2707
Practice Address - Country:US
Practice Address - Phone:314-898-6541
Practice Address - Fax:314-558-8448
Is Sole Proprietor?:Yes
Enumeration Date:2010-04-13
Last Update Date:2019-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR3636-C1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO1033541347Medicaid