Provider Demographics
NPI:1124710884
Name:ROBBINS, CANDICE (LPC)
Entity type:Individual
Prefix:
First Name:CANDICE
Middle Name:
Last Name:ROBBINS
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:210 W BURNSIDE AVE STE A
Mailing Address - Street 2:
Mailing Address - City:CHUBBUCK
Mailing Address - State:ID
Mailing Address - Zip Code:83202-4916
Mailing Address - Country:US
Mailing Address - Phone:208-238-9000
Mailing Address - Fax:208-238-9002
Practice Address - Street 1:9236 N SUNSET DR
Practice Address - Street 2:
Practice Address - City:POCATELLO
Practice Address - State:ID
Practice Address - Zip Code:83201-9017
Practice Address - Country:US
Practice Address - Phone:208-312-6977
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-05-22
Last Update Date:2023-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDLPC-9517101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health