Provider Demographics
NPI:1386391274
Name:RAINE, CANDACE M (LCSW, LICSW)
Entity type:Individual
Prefix:
First Name:CANDACE
Middle Name:M
Last Name:RAINE
Suffix:
Gender:F
Credentials:LCSW, LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 6082
Mailing Address - Street 2:
Mailing Address - City:SHERIDAN
Mailing Address - State:WY
Mailing Address - Zip Code:82801-1482
Mailing Address - Country:US
Mailing Address - Phone:307-429-2212
Mailing Address - Fax:
Practice Address - Street 1:1615 HOLMES AVE
Practice Address - Street 2:
Practice Address - City:SHERIDAN
Practice Address - State:WY
Practice Address - Zip Code:82801-2210
Practice Address - Country:US
Practice Address - Phone:307-429-2212
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-03-09
Last Update Date:2025-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WYLCSW-14221041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical