Basic Information
| Provider Information | |||||||||
| NPI: | 1043573967 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | EPPERSON | ||||||||
| FirstName: | CANDISE | ||||||||
| MiddleName: | ROSE | ||||||||
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| Credential: | QMHA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 66984 HIGHWAY 241 | ||||||||
| Address2: | |||||||||
| City: | COOS BAY | ||||||||
| State: | OR | ||||||||
| PostalCode: | 974206588 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5417207790 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 4422 NE DEVILS LAKE BLVD | ||||||||
| Address2: | |||||||||
| City: | LINCOLN CITY | ||||||||
| State: | OR | ||||||||
| PostalCode: | 973675000 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5412654196 | ||||||||
| FaxNumber: | 5419941882 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/18/2012 | ||||||||
| LastUpdateDate: | 10/25/2016 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YM0800X | Y | Behavioral Health & Social Service Providers | Counselor | Mental Health |
No ID Information.