Provider Demographics
NPI:1578720561
Name:SLADE, CANDACE
Entity Type:Individual
Prefix:MRS
First Name:CANDACE
Middle Name:
Last Name:SLADE
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 1:1507 WINONA BLVD
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90027-5003
Mailing Address - Country:US
Mailing Address - Phone:323-644-3500
Mailing Address - Fax:323-644-3505
Practice Address - Street 1:205 WORLD WAY
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90045-5807
Practice Address - Country:US
Practice Address - Phone:310-646-2270
Practice Address - Fax:310-646-1801
Is Sole Proprietor?:No
Enumeration Date:2008-05-19
Last Update Date:2008-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health