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General NPI Number Information
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NPI Number | 1831790229
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Entity Type | Individual
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Provider Name | CANDICE SHIN LCSW
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Gender | Female
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Dates
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Enumeration Date | 11/03/2020
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Last Update Date | 04/22/2025
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Provider Practice Location Address
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Address Line | 511 WALNUT AVE
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City | COLONIAL HEIGHTS
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State | VA
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Zip | 23834-2835
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Country | US
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Telephone | 804-601-8553
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Fax | 804-979-0373
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Provider Business Mailing Address
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Address Line | 7410 HULL STREET RD STE 200
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City | NORTH CHESTERFIELD
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State | VA
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Zip | 23235-5834
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Country | US
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Telephone | 804-601-8553
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Fax | 804-979-0373
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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 | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 0904017396
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License Number State | VA
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