Healthcare Provider Details

I. General information

NPI: 1033126081
Provider Name (Legal Business Name): CANDACE DIONELLE BLACK-RONEY LPC, SOTP, SATP CSAC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/02/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19234 TURKEY EGG RD
DINWIDDIE VA
23841-2128
US

IV. Provider business mailing address

19234 TURKEY EGG RD
DINWIDDIE VA
23841-2128
US

V. Phone/Fax

Practice location:
  • Phone: 804-586-2503
  • Fax: 804-469-9570
Mailing address:
  • Phone: 804-586-2503
  • Fax: 804-469-9570

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number0812000207
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number0701002775
License Number StateVA
# 3
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: