Individual
CANDICE WALLER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LPC-MHSP
Contact information
Practice address
5055 E BROADWAY BLVD STE C104, TUCSON, AZ 85711-3641
(520) 623-9833
(520) 923-9083
Mailing address
7670 N STAR GRASS DR, TUCSON, AZ 85741-4952
(678) 925-6598
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
LPC0000004067
TN
101YP2500X
Professional Counselor
Primary
LPC-19614
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
LPC-19614
LICENSE
AZ
Enumeration date
01/18/2019
Last updated
06/13/2022
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