Provider Demographics
NPI:1598258428
Name:THOMPSON, CANDACE (MS)
Entity Type:Individual
Prefix:MRS
First Name:CANDACE
Middle Name:
Last Name:THOMPSON
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2433 VALLEY AVE STE 105
Mailing Address - Street 2:
Mailing Address - City:WINCHESTER
Mailing Address - State:VA
Mailing Address - Zip Code:22601-6456
Mailing Address - Country:US
Mailing Address - Phone:540-550-1098
Mailing Address - Fax:
Practice Address - Street 1:2433 VALLEY AVE STE 105
Practice Address - Street 2:
Practice Address - City:WINCHESTER
Practice Address - State:VA
Practice Address - Zip Code:22601-6456
Practice Address - Country:US
Practice Address - Phone:540-550-1098
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-06-14
Last Update Date:2021-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0701007715101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health