Provider Demographics
NPI:1528607066
Name:DUBEAU, CANDICE GRACE
Entity Type:Individual
Prefix:
First Name:CANDICE
Middle Name:GRACE
Last Name:DUBEAU
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:CANDICE
Other - Middle Name:G
Other - Last Name:KOREBA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:BA
Mailing Address - Street 1:1312 SLATER ST
Mailing Address - Street 2:
Mailing Address - City:SUGAR GROVE
Mailing Address - State:IL
Mailing Address - Zip Code:60554-9823
Mailing Address - Country:US
Mailing Address - Phone:928-919-3139
Mailing Address - Fax:
Practice Address - Street 1:1312 SLATER ST
Practice Address - Street 2:
Practice Address - City:SUGAR GROVE
Practice Address - State:IL
Practice Address - Zip Code:60554-9823
Practice Address - Country:US
Practice Address - Phone:928-919-3139
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-01-01
Last Update Date:2020-01-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health