Basic Information
| Provider Information | |||||||||
| NPI: | 1033144092 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | STEWART | ||||||||
| FirstName: | CANDACE | ||||||||
| MiddleName: | |||||||||
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| Credential: | MSW | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2187 N VICKEY ST | ||||||||
| Address2: | |||||||||
| City: | FLAGSTAFF | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 860046121 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9287145286 | ||||||||
| FaxNumber: | 9287146480 | ||||||||
| Practice Location | |||||||||
| Address1: | 2187 N VICKEY ST | ||||||||
| Address2: | |||||||||
| City: | FLAGSTAFF | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 860046106 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9287146401 | ||||||||
| FaxNumber: | 9287146480 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/11/2006 | ||||||||
| LastUpdateDate: | 09/11/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 09/11/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041C0700X | LCSW-0316 | AZ | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No ID Information.