Provider Demographics
NPI:1356725121
Name:AIT ESSAHMI, CANDICE (LCSW-C)
Entity type:Individual
Prefix:MRS
First Name:CANDICE
Middle Name:
Last Name:AIT ESSAHMI
Suffix:
Gender:F
Credentials:LCSW-C
Other - Prefix:
Other - First Name:CANDICE
Other - Middle Name:
Other - Last Name:JOHNSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LGSW
Mailing Address - Street 1:SHAPE HEALTHCARE FACILITY
Mailing Address - Street 2:UNIT 21420 BOX 3530
Mailing Address - City:APO
Mailing Address - State:AE
Mailing Address - Zip Code:09705-1420
Mailing Address - Country:US
Mailing Address - Phone:314-566-5025
Mailing Address - Fax:
Practice Address - Street 1:SHAPE HEALTHCARE FACILITY
Practice Address - Street 2:BUILDING 401
Practice Address - City:APO
Practice Address - State:AE
Practice Address - Zip Code:09705-1420
Practice Address - Country:US
Practice Address - Phone:314-566-5025
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-07-12
Last Update Date:2022-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD180651041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical