Provider Demographics
NPI:1740843010
Name:LAWLER, CANDICE ALEXANDRA (CO 60942269)
Entity type:Individual
Prefix:
First Name:CANDICE
Middle Name:ALEXANDRA
Last Name:LAWLER
Suffix:
Gender:F
Credentials:CO 60942269
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:221 N RACE ST
Mailing Address - Street 2:
Mailing Address - City:PORT ANGELES
Mailing Address - State:WA
Mailing Address - Zip Code:98362-3513
Mailing Address - Country:US
Mailing Address - Phone:360-452-2443
Mailing Address - Fax:360-452-2738
Practice Address - Street 1:221 N RACE ST
Practice Address - Street 2:
Practice Address - City:PORT ANGELES
Practice Address - State:WA
Practice Address - Zip Code:98362-3513
Practice Address - Country:US
Practice Address - Phone:360-452-2443
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-04-22
Last Update Date:2019-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA60942269101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA60942269Medicaid