Provider Demographics
NPI:1760701304
Name:MOWREY, CANDICE CREASMAN (PHD, LCMHCS)
Entity Type:Individual
Prefix:
First Name:CANDICE
Middle Name:CREASMAN
Last Name:MOWREY
Suffix:
Gender:F
Credentials:PHD, LCMHCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:715 W MORGAN ST
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27603-1611
Mailing Address - Country:US
Mailing Address - Phone:919-977-0087
Mailing Address - Fax:919-890-0852
Practice Address - Street 1:715 W MORGAN ST
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27603-1611
Practice Address - Country:US
Practice Address - Phone:919-977-0087
Practice Address - Fax:919-890-0852
Is Sole Proprietor?:Yes
Enumeration Date:2010-05-21
Last Update Date:2021-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC7772101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional