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General NPI Number Information
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NPI Number | 1902536469
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Entity Type | Individual
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Provider Name | MARY CANDACE GLADNEY LCSW
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Gender | Female
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Dates
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Enumeration Date | 06/15/2022
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Last Update Date | 12/15/2025
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Provider Practice Location Address
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Address Line | 275 COUNTRY CLUB DR
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City | STOCKBRIDGE
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State | GA
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Zip | 30281-7349
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Country | US
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Telephone | 770-474-8400
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Fax |
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Provider Business Mailing Address
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Address Line | 213 EXPEDITION DR
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City | ELLENWOOD
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State | GA
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Zip | 30294-2276
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Country | US
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Telephone | 678-216-8692
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Fax |
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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 | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | CSW008121
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License Number State | GA
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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 | I.2507089
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License Number State | OH
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