Provider Demographics
NPI:1306085519
Name:FARMER, CANDACE MAYBERRY (MSW, LCSW)
Entity type:Individual
Prefix:MRS
First Name:CANDACE
Middle Name:MAYBERRY
Last Name:FARMER
Suffix:
Gender:F
Credentials:MSW, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13420 REESE BLVD W
Mailing Address - Street 2:
Mailing Address - City:HUNTERSVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28078-7925
Mailing Address - Country:US
Mailing Address - Phone:704-433-6644
Mailing Address - Fax:980-207-2796
Practice Address - Street 1:13420 REESE BLVD W
Practice Address - Street 2:
Practice Address - City:HUNTERSVILLE
Practice Address - State:NC
Practice Address - Zip Code:28078-7925
Practice Address - Country:US
Practice Address - Phone:704-433-6644
Practice Address - Fax:980-207-2796
Is Sole Proprietor?:Yes
Enumeration Date:2009-02-11
Last Update Date:2017-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCP0027191041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCC006688OtherLCSW
NCP002719OtherSOCIAL WORK CERTIFICATION AND LICENSURE
NC1831499086Medicare PIN