Provider Demographics
NPI:1295287183
Name:RIVINIUS, CANDACE (LPCC)
Entity type:Individual
Prefix:
First Name:CANDACE
Middle Name:
Last Name:RIVINIUS
Suffix:
Gender:
Credentials:LPCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4007 STATE ST STE 20
Mailing Address - Street 2:
Mailing Address - City:BISMARCK
Mailing Address - State:ND
Mailing Address - Zip Code:58503-0637
Mailing Address - Country:US
Mailing Address - Phone:701-751-8060
Mailing Address - Fax:701-751-8060
Practice Address - Street 1:4007 STATE ST STE 20
Practice Address - Street 2:
Practice Address - City:BISMARCK
Practice Address - State:ND
Practice Address - Zip Code:58503-0637
Practice Address - Country:US
Practice Address - Phone:701-751-8060
Practice Address - Fax:701-751-8060
Is Sole Proprietor?:No
Enumeration Date:2016-10-26
Last Update Date:2025-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND848-8-15-15101YP2500X
ND848-8-15-15A101YP2500X
ND848-8-15-515101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional