Provider Demographics
NPI:1609119395
Name:MAHAFFEY, CANDACE D (LPC)
Entity Type:Individual
Prefix:MRS
First Name:CANDACE
Middle Name:D
Last Name:MAHAFFEY
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 770
Mailing Address - Street 2:
Mailing Address - City:GARDENDALE
Mailing Address - State:TX
Mailing Address - Zip Code:79758-0770
Mailing Address - Country:US
Mailing Address - Phone:903-245-6217
Mailing Address - Fax:
Practice Address - Street 1:401 E ILLINOIS AVE
Practice Address - Street 2:
Practice Address - City:MIDLAND
Practice Address - State:TX
Practice Address - Zip Code:79701-4803
Practice Address - Country:US
Practice Address - Phone:432-570-3300
Practice Address - Fax:432-570-3426
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-01
Last Update Date:2013-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX67521101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional