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General NPI Number Information
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NPI Number | 1023673647
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Entity Type | Individual
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Provider Name | CANDACE E GUTHERY LICSW, PIP
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Gender | Female
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Dates
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Enumeration Date | 05/08/2019
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Last Update Date | 05/08/2019
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Provider Practice Location Address
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Address Line | 16 MOULTON ST E
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City | DECATUR
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State | AL
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Zip | 35601-2310
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Country | US
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Telephone | 256-822-2375
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Fax |
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Provider Business Mailing Address
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Address Line | 16 MOULTON ST E
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City | DECATUR
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State | AL
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Zip | 35601-2310
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Country | US
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Telephone | 256-822-2375
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 3792C
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License Number State | AL
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