Provider Demographics
NPI:1386780674
Name:WORTHINGTON, CANDACE L (LMSW)
Entity type:Individual
Prefix:
First Name:CANDACE
Middle Name:L
Last Name:WORTHINGTON
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:622 W SUPERIOR ST
Mailing Address - Street 2:
Mailing Address - City:MUNISING
Mailing Address - State:MI
Mailing Address - Zip Code:49862-1329
Mailing Address - Country:US
Mailing Address - Phone:906-387-4721
Mailing Address - Fax:906-387-1750
Practice Address - Street 1:622 W SUPERIOR ST
Practice Address - Street 2:
Practice Address - City:MUNISING
Practice Address - State:MI
Practice Address - Zip Code:49862-1329
Practice Address - Country:US
Practice Address - Phone:906-387-4721
Practice Address - Fax:906-387-1750
Is Sole Proprietor?:No
Enumeration Date:2007-01-30
Last Update Date:2008-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010666951041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical