Provider Demographics
NPI:1841656709
Name:WILLIAMS, CANDICE (PLPC)
Entity type:Individual
Prefix:
First Name:CANDICE
Middle Name:
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:PLPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:536 PELICAN ISLAND DR
Mailing Address - Street 2:APT. 1
Mailing Address - City:FLORISSANT
Mailing Address - State:MO
Mailing Address - Zip Code:63031-8707
Mailing Address - Country:US
Mailing Address - Phone:314-323-1499
Mailing Address - Fax:
Practice Address - Street 1:536 PELICAN ISLAND DR
Practice Address - Street 2:APT. 1
Practice Address - City:FLORISSANT
Practice Address - State:MO
Practice Address - Zip Code:63031-8707
Practice Address - Country:US
Practice Address - Phone:314-323-1499
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-01-07
Last Update Date:2016-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2015042816101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional