Provider Demographics
NPI:1821449638
Name:CARR, CANDICE L (MS)
Entity Type:Individual
Prefix:MS
First Name:CANDICE
Middle Name:L
Last Name:CARR
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1033 S WESTLAKE AVE APT 11
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90006-3747
Mailing Address - Country:US
Mailing Address - Phone:323-363-6570
Mailing Address - Fax:
Practice Address - Street 1:900 CORPORATE CENTER DR
Practice Address - Street 2:
Practice Address - City:MONTEREY PARK
Practice Address - State:CA
Practice Address - Zip Code:91754-7620
Practice Address - Country:US
Practice Address - Phone:323-526-4016
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-06-23
Last Update Date:2018-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA92953106H00000X
CA106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist