Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 101YM0800X | Mental Health Counselor | 15250 | LA |
Y | 104100000X | Social Worker | 15250 | LA |
NPI | 1003410986 |
---|---|
Provider Name | Mrs. Candice Dryden |
First Address | Deville, LA 71328-8212 |
Second Address | Colfax, LA 71417-1807 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 23/11/2020 |
Last Update Date | 01/12/2020 |