MEDICARE: CANDICE GIVENS OMAR LCSW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	C013840	NC
2	1041C0700X	Clinical Social Worker	LCSW118571	CA

General Provider Information

NPI Number	:	1396331716
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CANDICE GIVENS OMAR LCSW

Provider Business Mailing Address
First Line	:	5451 VISTA VIEW CT
Second Line	:
City	:	RALEIGH
State	:	NC
Zip	:	27612-8711
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	5451 VISTA VIEW CT
Second Line	:
City	:	RALEIGH
State	:	NC
Zip	:	27612-8711
Country	:	US
Telephone Number	:	919-338-6992
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/20/2020
Last Update Date	:	10/25/2023

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