Provider Demographics
NPI:1871175414
Name:WHITE, CANDICE SAMPSON (LMSW)
Entity type:Individual
Prefix:
First Name:CANDICE
Middle Name:SAMPSON
Last Name:WHITE
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:800 OLD ROSWELL LAKES PKWY STE 220
Mailing Address - Street 2:
Mailing Address - City:ROSWELL
Mailing Address - State:GA
Mailing Address - Zip Code:30076-1667
Mailing Address - Country:US
Mailing Address - Phone:404-939-6891
Mailing Address - Fax:
Practice Address - Street 1:800 OLD ROSWELL LAKES PKWY STE 220
Practice Address - Street 2:
Practice Address - City:ROSWELL
Practice Address - State:GA
Practice Address - Zip Code:30076-1667
Practice Address - Country:US
Practice Address - Phone:404-939-6891
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-04-23
Last Update Date:2021-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAMSW009905104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker