Healthcare Provider Details

I. General information

NPI: 1699476374
Provider Name (Legal Business Name): CANDACE ERIN CRAIG LMSW U/S
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/10/2023
Last Update Date: 04/22/2026
Certification Date: 04/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

550 W B ST FL 4
SAN DIEGO CA
92101-3537
US

IV. Provider business mailing address

550 W B ST FL 4
SAN DIEGO CA
92101-3537
US

V. Phone/Fax

Practice location:
  • Phone: 417-212-5494
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number20981
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: