Provider Demographics
NPI:1427658178
Name:CRENSHAW, CANDICE BIANCA (LPC, MS)
Entity type:Individual
Prefix:
First Name:CANDICE
Middle Name:BIANCA
Last Name:CRENSHAW
Suffix:
Gender:F
Credentials:LPC, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:303 BOYCE RD
Mailing Address - Street 2:
Mailing Address - City:DOTHAN
Mailing Address - State:AL
Mailing Address - Zip Code:36305-8407
Mailing Address - Country:US
Mailing Address - Phone:334-655-4522
Mailing Address - Fax:334-460-0899
Practice Address - Street 1:1 CHASE CORPORATE CENTER DR
Practice Address - Street 2:STE 110
Practice Address - City:HOOVER
Practice Address - State:AL
Practice Address - Zip Code:35244
Practice Address - Country:US
Practice Address - Phone:205-905-8497
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-10-30
Last Update Date:2024-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YP2500X
ALLPC04539101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional