Individual
CANDICE PHILLIPS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
621 W MADRONE ST, ROSEBURG, OR 97470-3090
(541) 492-4550
Mailing address
PO BOX 1121, ROSEBURG, OR 97470-0254
(541) 492-4550
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
10008606
OR
164W00000X
Licensed Practical Nurse
Primary
10008606
OR
171M00000X
Case Manager/Care Coordinator
—
—
172V00000X
Community Health Worker
—
—
Other
Enumeration date
05/22/2023
Last updated
05/22/2023
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