Provider Demographics
NPI:1588098461
Name:MANCHESTER, CANDACE LYNNE (LIMHP, LADC)
Entity type:Individual
Prefix:
First Name:CANDACE
Middle Name:LYNNE
Last Name:MANCHESTER
Suffix:
Gender:F
Credentials:LIMHP, LADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11840 NICHOLAS ST STE 205
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68154-4475
Mailing Address - Country:US
Mailing Address - Phone:402-867-6386
Mailing Address - Fax:
Practice Address - Street 1:11840 NICHOLAS ST STE 205
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68154-4475
Practice Address - Country:US
Practice Address - Phone:402-867-6386
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-27
Last Update Date:2023-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE1163101YA0400X
NEP-1160101YA0400X
NE1556101YM0800X
NE10060101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health