Provider Demographics
NPI:1447963954
Name:STIRMAN, KANDYCE LEE (CADC-R, CRM, THW)
Entity type:Individual
Prefix:
First Name:KANDYCE
Middle Name:LEE
Last Name:STIRMAN
Suffix:
Gender:F
Credentials:CADC-R, CRM, THW
Other - Prefix:
Other - First Name:KANDYCE
Other - Middle Name:LEE
Other - Last Name:OLLIAN-WILLIAMS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CRM, THW
Mailing Address - Street 1:111 N MAIN ST STE A
Mailing Address - Street 2:
Mailing Address - City:LEBANON
Mailing Address - State:OR
Mailing Address - Zip Code:97355-2869
Mailing Address - Country:US
Mailing Address - Phone:541-409-9459
Mailing Address - Fax:
Practice Address - Street 1:38961 RIVER DR
Practice Address - Street 2:
Practice Address - City:LEBANON
Practice Address - State:OR
Practice Address - Zip Code:97355-8913
Practice Address - Country:US
Practice Address - Phone:503-302-2656
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-12-29
Last Update Date:2024-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORT-24-4023101YA0400X
OR22-CRM-1053175T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)