Provider Information for 1386391274
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CANDACE M RAINE LCSW, LICSW
Sex: Female
NPI: 1386391274
Last Updated: 2025-01-14
Certification Date: 2025-01-14
Certification Date: 2025-01-14
Details
| Name | Value | ||||||||
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| NPI | 1386391274 | ||||||||
| Enumeration Date | 2022-03-09 | ||||||||
| NPI Type | NPI-1 Individual | ||||||||
| Sole Proprietor | NO | ||||||||
| Status | Active | ||||||||
| Mailing Address | PO BOX 6082 SHERIDAN, WY 82801-1482 United States Phone: 307-429-2212 | Fax: | ||||||||
| Primary Practice Address | 1615 HOLMES AVE SHERIDAN, WY 82801-2210 United States Phone: 307-429-2212 | Fax: | ||||||||
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