Provider Demographics
NPI:1760773527
Name:JACKSON, CANDACE SMITH (LPC)
Entity Type:Individual
Prefix:MS
First Name:CANDACE
Middle Name:SMITH
Last Name:JACKSON
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:MS
Other - First Name:CANDACE
Other - Middle Name:DEANNA
Other - Last Name:SMITH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:406 PARKER IVEY DR
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29607-6513
Mailing Address - Country:US
Mailing Address - Phone:864-395-6786
Mailing Address - Fax:864-900-0452
Practice Address - Street 1:406 PARKER IVEY DR
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29607-6513
Practice Address - Country:US
Practice Address - Phone:864-395-6786
Practice Address - Fax:864-900-0452
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-28
Last Update Date:2022-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC5725101YM0800X
101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health