Provider Demographics
NPI:1396331716
Name:OMAR, CANDICE GIVENS (LCSW)
Entity type:Individual
Prefix:
First Name:CANDICE
Middle Name:GIVENS
Last Name:OMAR
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:CANDICE
Other - Middle Name:LATONYA
Other - Last Name:GIVENS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:5451 VISTA VIEW CT
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27612-8711
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:5451 VISTA VIEW CT
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27612-8711
Practice Address - Country:US
Practice Address - Phone:919-338-6992
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-20
Last Update Date:2023-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCC0138401041C0700X
CALCSW1185711041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical