Provider Demographics
NPI:1659073526
Name:DAVIS, CANDICE M
Entity Type:Individual
Prefix:MS
First Name:CANDICE
Middle Name:M
Last Name:DAVIS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3600 JACKSON ST STE 119
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:LA
Mailing Address - Zip Code:71303-3096
Mailing Address - Country:US
Mailing Address - Phone:318-625-7050
Mailing Address - Fax:318-625-7197
Practice Address - Street 1:1521 AMULET ST
Practice Address - Street 2:
Practice Address - City:NATCHITOCHES
Practice Address - State:LA
Practice Address - Zip Code:71457-3303
Practice Address - Country:US
Practice Address - Phone:318-527-1694
Practice Address - Fax:318-527-1694
Is Sole Proprietor?:No
Enumeration Date:2023-03-21
Last Update Date:2023-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator