Provider Demographics
NPI:1912243080
Name:BETTS, CANDICE N (LLMSW)
Entity Type:Individual
Prefix:MS
First Name:CANDICE
Middle Name:N
Last Name:BETTS
Suffix:
Gender:F
Credentials:LLMSW
Other - Prefix:MS
Other - First Name:CANDICE
Other - Middle Name:NICOLE
Other - Last Name:BETTS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LLMSW
Mailing Address - Street 1:19453 OAKFIELD ST
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48235-2215
Mailing Address - Country:US
Mailing Address - Phone:313-702-8272
Mailing Address - Fax:
Practice Address - Street 1:19453 OAKFIELD ST
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48235-2215
Practice Address - Country:US
Practice Address - Phone:313-702-8272
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-12-18
Last Update Date:2012-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6801094923104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker