Provider Demographics
NPI:1770001174
Name:CHILDS, CANDICE MAE (QMHS)
Entity type:Individual
Prefix:
First Name:CANDICE
Middle Name:MAE
Last Name:CHILDS
Suffix:
Gender:F
Credentials:QMHS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1131 MANCHESTER AVE FL 2
Mailing Address - Street 2:
Mailing Address - City:MIDDLETOWN
Mailing Address - State:OH
Mailing Address - Zip Code:45042-1925
Mailing Address - Country:US
Mailing Address - Phone:513-422-4004
Mailing Address - Fax:513-422-4807
Practice Address - Street 1:1131 MANCHESTER AVE FL 2
Practice Address - Street 2:
Practice Address - City:MIDDLETOWN
Practice Address - State:OH
Practice Address - Zip Code:45042-1925
Practice Address - Country:US
Practice Address - Phone:513-422-4004
Practice Address - Fax:513-422-4807
Is Sole Proprietor?:No
Enumeration Date:2017-09-06
Last Update Date:2017-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker