Individual
MRS. CANDACE MIREA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LCSW, LAC
Contact information
Practice address
2809 CONNERY WAY STE B, MISSOULA, MT 59808-1955
(208) 502-0664
Mailing address
2809 CONNERY WAY STE B, MISSOULA, MT 59808-1955
(208) 502-0664
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
BBH-LAC-LIC-18799
MT
1041C0700X
Clinical Social Worker
Primary
BBH-LCSW-LIC-32896
MT
Other
Enumeration date
09/28/2016
Last updated
06/18/2020
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