Provider Demographics
NPI:1689758351
Name:SHOCKLEY, CANDACE LAVERNE (MA)
Entity Type:Individual
Prefix:
First Name:CANDACE
Middle Name:LAVERNE
Last Name:SHOCKLEY
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2166 HAYES ST
Mailing Address - Street 2:303
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94117-1033
Mailing Address - Country:US
Mailing Address - Phone:415-379-7201
Mailing Address - Fax:
Practice Address - Street 1:2166 HAYES ST
Practice Address - Street 2:303
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94117-1033
Practice Address - Country:US
Practice Address - Phone:415-379-7201
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA41711106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist