Provider Demographics
NPI:1174766422
Name:MCDANIEL, CANDACE JA (MSW)
Entity type:Individual
Prefix:MRS
First Name:CANDACE
Middle Name:JA
Last Name:MCDANIEL
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:CANDACE
Other - Middle Name:JA
Other - Last Name:JOHNSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2226 N 500 W
Mailing Address - Street 2:
Mailing Address - City:KOKOMO
Mailing Address - State:IN
Mailing Address - Zip Code:46901-8388
Mailing Address - Country:US
Mailing Address - Phone:765-480-0174
Mailing Address - Fax:317-858-8715
Practice Address - Street 1:2226 N 500 W
Practice Address - Street 2:
Practice Address - City:KOKOMO
Practice Address - State:IN
Practice Address - Zip Code:46901-8388
Practice Address - Country:US
Practice Address - Phone:765-480-0174
Practice Address - Fax:317-858-8715
Is Sole Proprietor?:Yes
Enumeration Date:2009-04-16
Last Update Date:2009-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical