MEDICARE: CANDICE SMITH LCSW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	C7516	MS

General Provider Information

NPI Number	:	1487835567
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CANDICE SMITH LCSW

Provider Business Mailing Address
First Line	:	PO BOX 518
Second Line	:
City	:	TCHULA
State	:	MS
Zip	:	39169-0518
Country	:	US
Telephone Number	:	662-299-3264
Fax Number	:

Provider Business Practice Location Address
First Line	:	16067 M. L. K. DR.
Second Line	:
City	:	TCHULA
State	:	MS
Zip	:	39169-0518
Country	:	US
Telephone Number	:	662-299-3264
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/17/2007
Last Update Date	:	01/03/2014

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