Healthcare Provider Details

I. General information

NPI: 1578607511
Provider Name (Legal Business Name): CANDICE CHRISTINE CAMPBELL LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/15/2007
Last Update Date: 05/18/2026
Certification Date: 05/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1886 BLAKESLEE AVE
ARCATA CA
95521-5417
US

IV. Provider business mailing address

1886 BLAKESLEE AVE
ARCATA CA
95521-5417
US

V. Phone/Fax

Practice location:
  • Phone: 707-572-5353
  • Fax:
Mailing address:
  • Phone: 707-572-5353
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number25328
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: