Provider Demographics
NPI:1639585367
Name:GLAVIANO, CANDACE A (LPCMH, CCDP-D, NCC)
Entity Type:Individual
Prefix:
First Name:CANDACE
Middle Name:A
Last Name:GLAVIANO
Suffix:
Gender:F
Credentials:LPCMH, CCDP-D, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:107 APOORVA LN
Mailing Address - Street 2:
Mailing Address - City:SMYRNA
Mailing Address - State:DE
Mailing Address - Zip Code:19977-4810
Mailing Address - Country:US
Mailing Address - Phone:443-907-2739
Mailing Address - Fax:
Practice Address - Street 1:107 APOORVA LN
Practice Address - Street 2:
Practice Address - City:SMYRNA
Practice Address - State:DE
Practice Address - Zip Code:19977-4810
Practice Address - Country:US
Practice Address - Phone:443-907-2739
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-07-02
Last Update Date:2016-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YA0400X
DEPC-0000761101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)