Provider Demographics
NPI:1679075360
Name:STICKMAN, CANDACE MARIE
Entity Type:Individual
Prefix:
First Name:CANDACE
Middle Name:MARIE
Last Name:STICKMAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:CANDACE
Other - Middle Name:MARIE
Other - Last Name:BURHOOP
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PLADC
Mailing Address - Street 1:1900 VICKI LN
Mailing Address - Street 2:
Mailing Address - City:NORFOLK
Mailing Address - State:NE
Mailing Address - Zip Code:68701-4558
Mailing Address - Country:US
Mailing Address - Phone:402-370-3140
Mailing Address - Fax:
Practice Address - Street 1:1900 VICKI LN
Practice Address - Street 2:
Practice Address - City:NORFOLK
Practice Address - State:NE
Practice Address - Zip Code:68701-4558
Practice Address - Country:US
Practice Address - Phone:402-370-3140
Practice Address - Fax:402-379-1397
Is Sole Proprietor?:No
Enumeration Date:2018-03-08
Last Update Date:2024-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YA0400X
NEP-2144101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE$$$$$$$$$Medicaid