Provider Demographics
NPI:1285097345
Name:SMITH, CANDICE RACHEL (LPCA)
Entity type:Individual
Prefix:MRS
First Name:CANDICE
Middle Name:RACHEL
Last Name:SMITH
Suffix:
Gender:F
Credentials:LPCA
Other - Prefix:
Other - First Name:CANDICE
Other - Middle Name:RACHEL
Other - Last Name:TYNES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:8316 AMBER LANTERN ST
Mailing Address - Street 2:APARTMENT 207
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27613-4582
Mailing Address - Country:US
Mailing Address - Phone:919-464-7398
Mailing Address - Fax:
Practice Address - Street 1:8512 SIX FORKS RD STE 101
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27615-3256
Practice Address - Country:US
Practice Address - Phone:919-464-7398
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-04-05
Last Update Date:2016-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCA12107101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCA12107OtherNORTH CAROLINA BOARD OF LICENSED PROFESSIONAL COUNSELORS