Provider Demographics
NPI:1194845453
Name:DUDLEY, KANDI MARTEL
Entity Type:Individual
Prefix:MISS
First Name:KANDI
Middle Name:MARTEL
Last Name:DUDLEY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1336 SINGINGWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:POMONA
Mailing Address - State:CA
Mailing Address - Zip Code:91767-4114
Mailing Address - Country:US
Mailing Address - Phone:323-547-8977
Mailing Address - Fax:
Practice Address - Street 1:17215 STUDEBAKER RD
Practice Address - Street 2:SUITE 110
Practice Address - City:CERRITOS
Practice Address - State:CA
Practice Address - Zip Code:90703-2548
Practice Address - Country:US
Practice Address - Phone:323-547-8977
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-30
Last Update Date:2021-05-25
Deactivation Date:2020-10-16
Deactivation Code:
Reactivation Date:2021-05-25
Provider Licenses
StateLicense IDTaxonomies
CA47408106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist