Individual
CANDICE MARIE MORTENSEN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LCMHCA
Contact information
Practice address
8512 SIX FORKS RD STE 101, RALEIGH, NC 27615-3256
(919) 277-0253
Mailing address
8512 SIX FORKS RD STE 101, RALEIGH, NC 27615-3256
(919) 277-0253
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
8148206-6009
UT
101YM0800X
Mental Health Counselor
Primary
A18236
NC
Other
Enumeration date
04/05/2012
Last updated
12/08/2022
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