Provider Demographics
NPI:1013341692
Name:HARRIS, CANDACE BROOK (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:CANDACE
Middle Name:BROOK
Last Name:HARRIS
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 1:215 WILLIAM PENN PLZ
Mailing Address - Street 2:APT 903
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27704-2564
Mailing Address - Country:US
Mailing Address - Phone:919-972-9626
Mailing Address - Fax:
Practice Address - Street 1:3500 WESTGATE DR
Practice Address - Street 2:SUITE 504C
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27707-2567
Practice Address - Country:US
Practice Address - Phone:919-972-9626
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-08-30
Last Update Date:2019-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCP0076171041C0700X
NCC0093871041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical