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General NPI Number Information
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NPI Number | 1609246347
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Entity Type | Organization
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Legal Business Name | CANDACE SAM, LLC
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Dates
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Enumeration Date | 10/06/2015
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Last Update Date | 02/09/2016
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Provider Practice Location Address
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Address Line | 6101 HAVELOCK AVE SUITE 2A
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City | LINCOLN
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State | NE
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Zip | 68507-1268
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Country | US
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Telephone | 702-353-0952
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Fax | 844-329-1465
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Provider Business Mailing Address
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Address Line | 6101 HAVELOCK AVE SUITE 2A
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City | LINCOLN
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State | NE
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Zip | 68507-1268
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Country | US
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Telephone | 702-353-0952
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Fax | 844-329-1465
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Authorized Official
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Title or Position | SOCIAL WORKER
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Name | CANDACE SAM
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Credential | LICSW
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Telephone | 702-353-0952
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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 | 1483, 1611
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License Number State | NE
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