Provider Demographics
NPI:1588744361
Name:SINDORIS, CANDACE J (LCSW, LSATP, CSAC)
Entity type:Individual
Prefix:
First Name:CANDACE
Middle Name:J
Last Name:SINDORIS
Suffix:
Gender:F
Credentials:LCSW, LSATP, CSAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1616 CHIMNEY HOUSE ROAD
Mailing Address - Street 2:
Mailing Address - City:RESTON
Mailing Address - State:VA
Mailing Address - Zip Code:20190-4301
Mailing Address - Country:US
Mailing Address - Phone:703-447-7615
Mailing Address - Fax:703-435-2112
Practice Address - Street 1:11260 ROGER BACON DR
Practice Address - Street 2:SUITE 500
Practice Address - City:RESTON
Practice Address - State:VA
Practice Address - Zip Code:20190-5227
Practice Address - Country:US
Practice Address - Phone:703-282-0166
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0718000073101YA0400X
VA09040038831041C0700X
CO911041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Not Answered1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA491851Medicare ID - Type Unspecified