Healthcare Provider Details

I. General information

NPI: 1396678587
Provider Name (Legal Business Name): CANDICE JOHNSON DOOLEY CPSS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/05/2026
Last Update Date: 06/05/2026
Certification Date: 06/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1421 BLUFF RD
COLUMBIA SC
29201-4809
US

IV. Provider business mailing address

1738 HOLLY HILL DR
WEST COLUMBIA SC
29169-5424
US

V. Phone/Fax

Practice location:
  • Phone: 877-848-9810
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License NumberCPSS-2752
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: