Provider Demographics
NPI:1649675430
Name:EUBANKS, CANDACE R (LCSW)
Entity type:Individual
Prefix:
First Name:CANDACE
Middle Name:R
Last Name:EUBANKS
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 73
Mailing Address - Street 2:
Mailing Address - City:UNION CITY
Mailing Address - State:TN
Mailing Address - Zip Code:38281-0073
Mailing Address - Country:US
Mailing Address - Phone:731-599-5026
Mailing Address - Fax:731-599-5027
Practice Address - Street 1:108 S 1ST ST
Practice Address - Street 2:
Practice Address - City:UNION CITY
Practice Address - State:TN
Practice Address - Zip Code:38261-3802
Practice Address - Country:US
Practice Address - Phone:731-599-5026
Practice Address - Fax:731-599-5027
Is Sole Proprietor?:Yes
Enumeration Date:2014-10-23
Last Update Date:2015-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN60321041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical