Provider Demographics
NPI:1770288623
Name:HUNTER, CANDICE MARIE (LCSW)
Entity type:Individual
Prefix:MS
First Name:CANDICE
Middle Name:MARIE
Last Name:HUNTER
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:PMB 1222
Mailing Address - Street 2:272 CALHOUN STATION PARKWAY, SUITE C
Mailing Address - City:MADISON
Mailing Address - State:MS
Mailing Address - Zip Code:39110
Mailing Address - Country:US
Mailing Address - Phone:662-444-9360
Mailing Address - Fax:601-706-1210
Practice Address - Street 1:272 CALHOUN STATION PARKWAY
Practice Address - Street 2:SUITE C
Practice Address - City:MADISON
Practice Address - State:MS
Practice Address - Zip Code:39110
Practice Address - Country:US
Practice Address - Phone:662-444-9360
Practice Address - Fax:601-706-1210
Is Sole Proprietor?:Yes
Enumeration Date:2023-03-31
Last Update Date:2023-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSC90331041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty