Provider Demographics
NPI:1356719660
Name:CRAIG, CANDICE JOY (LCSW)
Entity type:Individual
Prefix:
First Name:CANDICE
Middle Name:JOY
Last Name:CRAIG
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:CANDICE
Other - Middle Name:JOY
Other - Last Name:HAPPACH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:7521 S OLYMPIA AVE # 1021
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74132-1855
Mailing Address - Country:US
Mailing Address - Phone:918-322-1214
Mailing Address - Fax:
Practice Address - Street 1:10831 HARRISON
Practice Address - Street 2:
Practice Address - City:BEGGS
Practice Address - State:OK
Practice Address - Zip Code:74421
Practice Address - Country:US
Practice Address - Phone:918-322-1214
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-09-03
Last Update Date:2023-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCP0100971041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1356719660Medicaid
NC19EGBOtherBCBSNC