Healthcare Provider Details

I. General information

NPI: 1942143060
Provider Name (Legal Business Name): CANDICE MCDANIEL LSP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/13/2026
Last Update Date: 04/13/2026
Certification Date: 04/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

525 7TH ST NE
NORTH CANTON OH
44720-2012
US

IV. Provider business mailing address

525 7TH ST NE
NORTH CANTON OH
44720-2012
US

V. Phone/Fax

Practice location:
  • Phone: 330-497-5600
  • Fax:
Mailing address:
  • Phone: 330-497-5600
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License NumberLSP.00192
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: