Healthcare Provider Details

I. General information

NPI: 1386391274
Provider Name (Legal Business Name): CANDACE M RAINE LCSW, LICSW, CSW-PIP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/09/2022
Last Update Date: 12/08/2025
Certification Date: 12/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

612 STATE ST
BELLE FOURCHE SD
57717-1419
US

IV. Provider business mailing address

PO BOX 384
PIEDMONT SD
57769-0384
US

V. Phone/Fax

Practice location:
  • Phone: 307-429-2212
  • Fax:
Mailing address:
  • Phone: 307-429-2212
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number3174
License Number StateNH
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberCSW-PIP-6937
License Number StateSD
# 3
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLCSW-1422
License Number StateWY
# 4
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberBBH-LCSW-LIC-69833
License Number StateMT
# 5
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberTPSW2854
License Number StateFL
# 6
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberSWI.LW.31526090
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: