Provider Demographics
NPI:1124306493
Name:FIFER, CANDICE CORINNE (LCSW)
Entity type:Individual
Prefix:
First Name:CANDICE
Middle Name:CORINNE
Last Name:FIFER
Suffix:
Gender:
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:120 CORBINS CLOSE
Mailing Address - Street 2:
Mailing Address - City:WYOMING
Mailing Address - State:DE
Mailing Address - Zip Code:19934-2377
Mailing Address - Country:US
Mailing Address - Phone:302-535-6677
Mailing Address - Fax:302-351-6746
Practice Address - Street 1:120 CORBINS CLOSE
Practice Address - Street 2:
Practice Address - City:WYOMING
Practice Address - State:DE
Practice Address - Zip Code:19934-2377
Practice Address - Country:US
Practice Address - Phone:302-535-6677
Practice Address - Fax:302-351-6746
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-03
Last Update Date:2025-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEQ1-00010981041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
DE1124306493Medicaid