Healthcare Provider Details

I. General information

NPI: 1538405816
Provider Name (Legal Business Name): CANDACE IRENE GUILLORY STEPHENS MS, LMHC, ATR
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/14/2012
Last Update Date: 08/10/2026
Certification Date: 08/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1401 DEVINE ST
COLUMBIA SC
29208-3902
US

IV. Provider business mailing address

609 SUBER ST
COLUMBIA SC
29205-4130
US

V. Phone/Fax

Practice location:
  • Phone: 803-777-5223
  • Fax:
Mailing address:
  • Phone: 850-320-4110
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number12417
License Number StateSC
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number39003470A
License Number StateIN
# 3
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: