Provider Demographics
NPI:1699360768
Name:ROGERS, CANDACE (LCSW)
Entity Type:Individual
Prefix:
First Name:CANDACE
Middle Name:
Last Name:ROGERS
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:71 OLD BRIDGE DR
Mailing Address - Street 2:
Mailing Address - City:TAYLORSVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28681-8198
Mailing Address - Country:US
Mailing Address - Phone:828-302-5622
Mailing Address - Fax:
Practice Address - Street 1:71 OLD BRIDGE DR
Practice Address - Street 2:
Practice Address - City:TAYLORSVILLE
Practice Address - State:NC
Practice Address - Zip Code:28681-8198
Practice Address - Country:US
Practice Address - Phone:828-302-5622
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-03-01
Last Update Date:2024-01-04
Deactivation Date:2023-12-20
Deactivation Code:
Reactivation Date:2023-12-27
Provider Licenses
StateLicense IDTaxonomies
NCC0166721041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical