Provider Demographics
NPI:1205228939
Name:OGLESBY, CANDACE KELLY (LCPC)
Entity Type:Individual
Prefix:
First Name:CANDACE
Middle Name:KELLY
Last Name:OGLESBY
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1800 N CHARLES ST
Mailing Address - Street 2:206
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21201-5920
Mailing Address - Country:US
Mailing Address - Phone:443-388-9654
Mailing Address - Fax:443-388-9367
Practice Address - Street 1:1800 N CHARLES ST
Practice Address - Street 2:206
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21201-5920
Practice Address - Country:US
Practice Address - Phone:443-388-9654
Practice Address - Fax:443-388-9367
Is Sole Proprietor?:Yes
Enumeration Date:2015-03-04
Last Update Date:2015-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLC6193101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional