Provider Demographics
NPI:1043832504
Name:ISAACSON, CANDICE MARIE (LAC, LASAC)
Entity type:Individual
Prefix:
First Name:CANDICE
Middle Name:MARIE
Last Name:ISAACSON
Suffix:
Gender:F
Credentials:LAC, LASAC
Other - Prefix:
Other - First Name:CANDICE
Other - Middle Name:MARIE
Other - Last Name:STEWART
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2911 W SUNNYSIDE DR
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85029-3302
Mailing Address - Country:US
Mailing Address - Phone:623-980-6933
Mailing Address - Fax:
Practice Address - Street 1:2911 W SUNNYSIDE DR
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85029-3302
Practice Address - Country:US
Practice Address - Phone:623-980-6933
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-05-07
Last Update Date:2020-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ15132101YA0400X
AZ18701101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)