Provider Demographics
NPI:1689826976
Name:BROWN, CANDACE (LIC MARRIAGE & FAMI)
Entity Type:Individual
Prefix:
First Name:CANDACE
Middle Name:
Last Name:BROWN
Suffix:
Gender:F
Credentials:LIC MARRIAGE & FAMI
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 E. REDLANDS BLVD.
Mailing Address - Street 2:STE. 246
Mailing Address - City:REDLANDS
Mailing Address - State:CA
Mailing Address - Zip Code:92373
Mailing Address - Country:US
Mailing Address - Phone:909-798-2848
Mailing Address - Fax:909-794-6505
Practice Address - Street 1:101 E. REDLANDS BLVD
Practice Address - Street 2:STE. 246
Practice Address - City:REDLANDS
Practice Address - State:CA
Practice Address - Zip Code:92373
Practice Address - Country:US
Practice Address - Phone:909-798-2848
Practice Address - Fax:909-794-6505
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-17
Last Update Date:2008-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC19935106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist