Provider Demographics
NPI:1558192948
Name:HENDERSON, CANDICE (LADAC)
Entity type:Individual
Prefix:
First Name:CANDICE
Middle Name:
Last Name:HENDERSON
Suffix:
Gender:F
Credentials:LADAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3909 HIGHWAY 282
Mailing Address - Street 2:
Mailing Address - City:VAN BUREN
Mailing Address - State:AR
Mailing Address - Zip Code:72956-8718
Mailing Address - Country:US
Mailing Address - Phone:479-242-1003
Mailing Address - Fax:501-510-5917
Practice Address - Street 1:3909 HIGHWAY 282
Practice Address - Street 2:
Practice Address - City:VAN BUREN
Practice Address - State:AR
Practice Address - Zip Code:72956-8718
Practice Address - Country:US
Practice Address - Phone:479-242-1003
Practice Address - Fax:501-510-5917
Is Sole Proprietor?:Yes
Enumeration Date:2024-08-08
Last Update Date:2024-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR4891101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)