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General NPI Number Information
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NPI Number | 1861777849
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Entity Type | Organization
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Legal Business Name | CANDICE CARRASCO, PLLC
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Dates
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Enumeration Date | 10/20/2011
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Last Update Date | 11/28/2023
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Provider Practice Location Address
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Address Line | 2109 HAMILTON RD STE 100-A
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City | OKEMOS
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State | MI
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Zip | 48864-1772
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Country | US
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Telephone | 517-375-2672
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 10
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City | MASON
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State | MI
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Zip | 48854-0010
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER/CLINICAL SOCIAL WORKER
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Name | MRS. CANDICE M CARRASCO
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Credential | LMSW
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Telephone | 517-449-6312
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 104100000X
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Taxonomy Name | Social Worker
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License Number |
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License Number State |
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