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 384
Mailing Address - Street 2:
Mailing Address - City:PIEDMONT
Mailing Address - State:SD
Mailing Address - Zip Code:57769-0384
Mailing Address - Country:US
Mailing Address - Phone:307-429-2212
Mailing Address - Fax:
Practice Address - Street 1:612 STATE ST
Practice Address - Street 2:
Practice Address - City:BELLE FOURCHE
Practice Address - State:SD
Practice Address - Zip Code:57717-1419
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:2025-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH31741041C0700X
WYLCSW-14221041C0700X
MTBBH-LCSW-LIC-698331041C0700X
FLTPSW28541041C0700X
WASWI.LW.315260901041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical