Provider Demographics
NPI:1346372075
Name:TUBBS-DAVIDSON, CANDI LYNN
Entity Type:Individual
Prefix:MRS
First Name:CANDI
Middle Name:LYNN
Last Name:TUBBS-DAVIDSON
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 1:885 W 18TH ST
Mailing Address - Street 2:
Mailing Address - City:MERCED
Mailing Address - State:CA
Mailing Address - Zip Code:95340-4604
Mailing Address - Country:US
Mailing Address - Phone:209-726-3090
Mailing Address - Fax:209-722-7648
Practice Address - Street 1:4701 ENTERPRISE WAY
Practice Address - Street 2:
Practice Address - City:MODESTO
Practice Address - State:CA
Practice Address - Zip Code:95356-8715
Practice Address - Country:US
Practice Address - Phone:209-550-6016
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-09
Last Update Date:2024-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC50464106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist