Healthcare Provider Details

I. General information

NPI: 1114409232
Provider Name (Legal Business Name): CANDICE MARIE HAILE ASW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/05/2018
Last Update Date: 07/24/2023
Certification Date: 07/24/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9837 FOLSOM BLVD STE F
SACRAMENTO CA
95827-1356
US

IV. Provider business mailing address

9837 FOLSOM BLVD STE F
SACRAMENTO CA
95827-1356
US

V. Phone/Fax

Practice location:
  • Phone: 916-450-2600
  • Fax:
Mailing address:
  • Phone: 916-450-2600
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number102216
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number102216
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: