=====================================================
General NPI Number Information
=====================================================
NPI Number | 1841124161
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | CANDACE NOVAK
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/11/2026
-----------------------------------------------------
Last Update Date | 06/11/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 21331 KELLY RD
-----------------------------------------------------
City | EASTPOINTE
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 48021-3265
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 800-615-0411
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 32174 E BRAMPTON ST
-----------------------------------------------------
City | NEW HAVEN
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 48048-1970
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 586-381-8128
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 104100000X
-----------------------------------------------------
Taxonomy Name | Social Worker
-----------------------------------------------------
License Number | 6851121981
-----------------------------------------------------
License Number State | MI
-----------------------------------------------------