Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1041C0700X | Clinical Social Worker | 10838 | AZ |
NPI | 1003032194 |
---|---|
Provider Name | Ms. Candace Lynne Quibell |
First Address | Bisbee, AZ 85603-0513 |
Second Address | Bisbee, AZ 85603 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 17/04/2007 |
Last Update Date | 24/10/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
816308 | (05) | AZ |