1356725121 NPI number — MRS. CANDICE AIT ESSAHMI LCSW-C

Table of content: MRS. CANDICE AIT ESSAHMI LCSW-C (NPI 1356725121)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1356725121 NPI number — MRS. CANDICE AIT ESSAHMI LCSW-C

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
AIT ESSAHMI
Provider First Name:
CANDICE
Provider Middle Name:
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
LCSW-C
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
JOHNSON
Provider Other First Name:
CANDICE
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
LGSW
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1356725121
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/22/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
SHAPE HEALTHCARE FACILITY
Provider Second Line Business Mailing Address:
UNIT 21420 BOX 3530
Provider Business Mailing Address City Name:
APO
Provider Business Mailing Address State Name:
AE
Provider Business Mailing Address Postal Code:
09705-1420
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
314-566-5025
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
SHAPE HEALTHCARE FACILITY
Provider Second Line Business Practice Location Address:
BUILDING 401
Provider Business Practice Location Address City Name:
APO
Provider Business Practice Location Address State Name:
AE
Provider Business Practice Location Address Postal Code:
09705-1420
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
314-566-5025
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
07/12/2015

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 1041C0700X , with the licence number:  18065 , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





Copyright © 2007-2025 www.npivalidator.com