Provider Demographics
NPI:1114570025
Name:BENAVIDEZ, CANDACE ASHLEY (MS, LPC)
Entity Type:Individual
Prefix:MRS
First Name:CANDACE
Middle Name:ASHLEY
Last Name:BENAVIDEZ
Suffix:
Gender:F
Credentials:MS, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1919 NW LOOP 410 STE 201
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78213-2325
Mailing Address - Country:US
Mailing Address - Phone:210-733-7117
Mailing Address - Fax:210-733-7118
Practice Address - Street 1:1919 NW LOOP 410
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78213-2307
Practice Address - Country:US
Practice Address - Phone:210-733-3711
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-07-19
Last Update Date:2019-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX75867101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health