Provider Demographics
NPI:1023673647
Name:GUTHERY, CANDACE E (LICSW, PIP)
Entity type:Individual
Prefix:
First Name:CANDACE
Middle Name:E
Last Name:GUTHERY
Suffix:
Gender:F
Credentials:LICSW, PIP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16 MOULTON ST E
Mailing Address - Street 2:
Mailing Address - City:DECATUR
Mailing Address - State:AL
Mailing Address - Zip Code:35601-2310
Mailing Address - Country:US
Mailing Address - Phone:256-822-2375
Mailing Address - Fax:
Practice Address - Street 1:16 MOULTON ST E
Practice Address - Street 2:
Practice Address - City:DECATUR
Practice Address - State:AL
Practice Address - Zip Code:35601-2310
Practice Address - Country:US
Practice Address - Phone:256-822-2375
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-05-08
Last Update Date:2019-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL3792C1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical