Provider Demographics
NPI:1831790229
Name:SHIN, CANDICE (LCSW)
Entity type:Individual
Prefix:
First Name:CANDICE
Middle Name:
Last Name:SHIN
Suffix:
Gender:
Credentials:LCSW
Other - Prefix:
Other - First Name:CANDICE
Other - Middle Name:
Other - Last Name:SHIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:7410 HULL STREET RD STE 200
Mailing Address - Street 2:
Mailing Address - City:NORTH CHESTERFIELD
Mailing Address - State:VA
Mailing Address - Zip Code:23235-5834
Mailing Address - Country:US
Mailing Address - Phone:804-601-8553
Mailing Address - Fax:804-979-0373
Practice Address - Street 1:511 WALNUT AVE
Practice Address - Street 2:
Practice Address - City:COLONIAL HEIGHTS
Practice Address - State:VA
Practice Address - Zip Code:23834-2835
Practice Address - Country:US
Practice Address - Phone:804-601-8553
Practice Address - Fax:804-979-0373
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-03
Last Update Date:2025-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
VA09040173961041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA30018025690001Medicaid