Provider Demographics
NPI:1821103490
Name:LYLES, CANDACE V (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:CANDACE
Middle Name:V
Last Name:LYLES
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5400 E OLYMPIC BLVD
Mailing Address - Street 2:SUITE150
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90022-5147
Mailing Address - Country:US
Mailing Address - Phone:323-725-7557
Mailing Address - Fax:323-725-7577
Practice Address - Street 1:5400 E OLYMPIC BLVD
Practice Address - Street 2:SUITE150
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90022-5147
Practice Address - Country:US
Practice Address - Phone:323-725-7557
Practice Address - Fax:323-725-7577
Is Sole Proprietor?:No
Enumeration Date:2006-08-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA101871041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical