Provider Demographics
NPI:1184973554
Name:LEWIS, CANDICE R (MS, NCC, LPC)
Entity type:Individual
Prefix:MS
First Name:CANDICE
Middle Name:R
Last Name:LEWIS
Suffix:
Gender:F
Credentials:MS, NCC, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:228 SOUTH MAIN ST
Mailing Address - Street 2:
Mailing Address - City:SCRANTON
Mailing Address - State:PA
Mailing Address - Zip Code:18504
Mailing Address - Country:US
Mailing Address - Phone:570-291-7919
Mailing Address - Fax:
Practice Address - Street 1:228 S MAIN ST
Practice Address - Street 2:
Practice Address - City:SCRANTON
Practice Address - State:PA
Practice Address - Zip Code:18504
Practice Address - Country:US
Practice Address - Phone:570-291-7919
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-08-31
Last Update Date:2021-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPC007991101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional