Provider Demographics
NPI:1952452369
Name:COKER SMITH, CANDACE (LCSW)
Entity Type:Individual
Prefix:MS
First Name:CANDACE
Middle Name:
Last Name:COKER SMITH
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 1:3500 SAULS DR
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78728-3551
Mailing Address - Country:US
Mailing Address - Phone:512-680-0425
Mailing Address - Fax:512-238-6348
Practice Address - Street 1:1970 RAWHIDE DR
Practice Address - Street 2:
Practice Address - City:ROUND ROCK
Practice Address - State:TX
Practice Address - Zip Code:78681-6957
Practice Address - Country:US
Practice Address - Phone:512-680-0425
Practice Address - Fax:512-238-6348
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX350901041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical