Provider Demographics
NPI:1225815517
Name:CLYBURN-GAMBLE, CANDACE CHARLEY (LCMHC-A)
Entity Type:Individual
Prefix:
First Name:CANDACE
Middle Name:CHARLEY
Last Name:CLYBURN-GAMBLE
Suffix:
Gender:F
Credentials:LCMHC-A
Other - Prefix:
Other - First Name:CANDANCE
Other - Middle Name:CHARLEY
Other - Last Name:CLYBURN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:8535 CLIFF CAMERON DR STE 100
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28269
Mailing Address - Country:US
Mailing Address - Phone:704-717-7477
Mailing Address - Fax:704-717-7457
Practice Address - Street 1:8535 CLIFF CAMERON DR STE 100
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28269-2826
Practice Address - Country:US
Practice Address - Phone:704-717-7477
Practice Address - Fax:704-717-7457
Is Sole Proprietor?:Yes
Enumeration Date:2023-09-11
Last Update Date:2023-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health