Provider Demographics
NPI:1205694056
Name:DAVIS, CANDACE MARIE (MSW)
Entity type:Individual
Prefix:MRS
First Name:CANDACE
Middle Name:MARIE
Last Name:DAVIS
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7627 MALONE RD
Mailing Address - Street 2:
Mailing Address - City:OLIVE BRANCH
Mailing Address - State:MS
Mailing Address - Zip Code:38654-6123
Mailing Address - Country:US
Mailing Address - Phone:901-871-6919
Mailing Address - Fax:901-424-9070
Practice Address - Street 1:8304 WALNUT GROVE RD
Practice Address - Street 2:
Practice Address - City:CORDOVA
Practice Address - State:TN
Practice Address - Zip Code:38018-6869
Practice Address - Country:US
Practice Address - Phone:901-501-7700
Practice Address - Fax:901-424-9070
Is Sole Proprietor?:No
Enumeration Date:2024-03-07
Last Update Date:2024-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health