Provider Demographics
NPI:1801510508
Name:WOLTERS, CANDACE (LMSW)
Entity type:Individual
Prefix:
First Name:CANDACE
Middle Name:
Last Name:WOLTERS
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:CANDACE
Other - Middle Name:
Other - Last Name:COUPER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMSW
Mailing Address - Street 1:10942 N LINNET RD
Mailing Address - Street 2:
Mailing Address - City:CASA GRANDE
Mailing Address - State:AZ
Mailing Address - Zip Code:85194-7106
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:43491 N COYOTE RD
Practice Address - Street 2:
Practice Address - City:SAN TAN VALLEY
Practice Address - State:AZ
Practice Address - Zip Code:85140-8924
Practice Address - Country:US
Practice Address - Phone:781-775-4513
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-09-27
Last Update Date:2022-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLMSW-17466104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker