Provider Demographics
NPI:1225751670
Name:JULES, CANDACE MILTRELLE (LICSW)
Entity Type:Individual
Prefix:
First Name:CANDACE
Middle Name:MILTRELLE
Last Name:JULES
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:CANDACE
Other - Middle Name:
Other - Last Name:JOHNSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:7540 MEMORIAL PKWY SW STE W
Mailing Address - Street 2:
Mailing Address - City:HUNTSVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35802-2208
Mailing Address - Country:US
Mailing Address - Phone:256-824-9171
Mailing Address - Fax:
Practice Address - Street 1:7540 MEMORIAL PKWY SW STE W
Practice Address - Street 2:
Practice Address - City:HUNTSVILLE
Practice Address - State:AL
Practice Address - Zip Code:35802-2208
Practice Address - Country:US
Practice Address - Phone:256-824-9171
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-09-21
Last Update Date:2023-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACG61440385104100000X, 104100000X
AL5450G1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL5450GOtherLICENSE
5874OtherHEALTH PARTNERS
DC236Medicaid
568946544OtherBCBS