=====================================================
General NPI Number Information
=====================================================
NPI Number | 1598673899
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | CANDICE SA PLLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/29/2026
-----------------------------------------------------
Last Update Date | 08/29/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2363 DEVIN AVE
-----------------------------------------------------
City | CARSON CITY
-----------------------------------------------------
State | NV
-----------------------------------------------------
Zip | 89701-7419
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 702-494-7763
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2363 DEVIN AVE
-----------------------------------------------------
City | CARSON CITY
-----------------------------------------------------
State | NV
-----------------------------------------------------
Zip | 89701-7419
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 702-494-7763
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | CANDICE SA
-----------------------------------------------------
Credential | LCSW
-----------------------------------------------------
Telephone | 702-494-7763
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1041C0700X
-----------------------------------------------------
Taxonomy Name | Clinical Social Worker
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------