Provider Demographics
NPI:1265735302
Name:GADISON, CANDI L (LCSW)
Entity type:Individual
Prefix:
First Name:CANDI
Middle Name:L
Last Name:GADISON
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:936 W CLARK ST
Mailing Address - Street 2:
Mailing Address - City:BARTLETT
Mailing Address - State:TX
Mailing Address - Zip Code:76511-4076
Mailing Address - Country:US
Mailing Address - Phone:129-661-0745
Mailing Address - Fax:
Practice Address - Street 1:3613 WILLIAMS DR STE 302
Practice Address - Street 2:
Practice Address - City:GEORGETOWN
Practice Address - State:TX
Practice Address - Zip Code:78628-1369
Practice Address - Country:US
Practice Address - Phone:512-966-1074
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-12-13
Last Update Date:2022-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX171M00000X
TX510091041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No171M00000XOther Service ProvidersCase Manager/Care Coordinator
Provider Identifiers
StateIdentifier IDID TypeIssuer
NONEOtherN/A