Healthcare Provider Details

I. General information

NPI: 1215847330
Provider Name (Legal Business Name): ALICIA MADELINE CANDIA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/10/2026
Last Update Date: 09/10/2026
Certification Date: 09/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

161 BUSH RIVER DR
FARMVILLE VA
23901-3183
US

IV. Provider business mailing address

161 BUSH RIVER DR
FARMVILLE VA
23901-3183
US

V. Phone/Fax

Practice location:
  • Phone: 434-392-7049
  • Fax: 434-225-9415
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number0701016740
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: