MEDICARE: CANDICE THOMPSON

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	17630	SC

General Provider Information

NPI Number	:	1457202038
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CANDICE THOMPSON

Provider Business Mailing Address
First Line	:	6650 RIVERS AVE STE 100
Second Line	:
City	:	NORTH CHARLESTON
State	:	SC
Zip	:	29406-4809
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	6650 RIVERS AVE STE 100
Second Line	:
City	:	NORTH CHARLESTON
State	:	SC
Zip	:	29406-4809
Country	:	US
Telephone Number	:	919-619-7879
Fax Number	:

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

Provider Enumeration Date	:	02/09/2026
Last Update Date	:	02/09/2026

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Directions to “ CANDICE THOMPSON ” Practice Location

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