Provider Demographics
NPI:1558377028
Name:MOORE, CANDACE MARIE (MFT)
Entity Type:Individual
Prefix:
First Name:CANDACE
Middle Name:MARIE
Last Name:MOORE
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4050 BARRANCA PKWY STE 160
Mailing Address - Street 2:
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92604-4785
Mailing Address - Country:US
Mailing Address - Phone:949-551-0252
Mailing Address - Fax:949-559-4071
Practice Address - Street 1:4050 BARRANCA PKWY STE 160
Practice Address - Street 2:
Practice Address - City:IRVINE
Practice Address - State:CA
Practice Address - Zip Code:92604-4785
Practice Address - Country:US
Practice Address - Phone:949-551-0252
Practice Address - Fax:949-559-4071
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC17964101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional