Individual
CANDACE D FAIR
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LCSW
Contact information
Practice address
12 N KINGSHIGHWAY, PERRYVILLE, MO 63775
(573) 547-3116
Mailing address
214 W ST FRANCIS ST, PERRYVILLE, MO 63775
(573) 547-1145
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
005110
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
114540
BLUE CROSS
MO
Enumeration date
08/23/2006
Last updated
07/08/2007
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