Healthcare Provider Details

I. General information

NPI: 1831790229
Provider Name (Legal Business Name): CANDICE SHIN LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: CANDICE SHIN

II. Dates (important events)

Enumeration Date: 11/03/2020
Last Update Date: 04/22/2025
Certification Date: 04/22/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

511 WALNUT AVE
COLONIAL HEIGHTS VA
23834-2835
US

IV. Provider business mailing address

7410 HULL STREET RD STE 200
NORTH CHESTERFIELD VA
23235-5834
US

V. Phone/Fax

Practice location:
  • Phone: 804-601-8553
  • Fax: 804-979-0373
Mailing address:
  • Phone: 804-601-8553
  • Fax: 804-979-0373

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number0904017396
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: