Healthcare Provider Details

I. General information

NPI: 1346131968
Provider Name (Legal Business Name): CANDACE VICE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/11/2025
Last Update Date: 07/11/2025
Certification Date: 07/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4317 HARFORD RD
BALTIMORE MD
21214-3118
US

IV. Provider business mailing address

9613 HARFORD RD STE C1049
PARKVILLE MD
21234-2150
US

V. Phone/Fax

Practice location:
  • Phone: 410-275-0994
  • Fax:
Mailing address:
  • Phone: 410-262-8000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number20351
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: