Provider Demographics
NPI:1891832036
Name:CANDELARIA, GINA MARIA (MED MC LPC)
Entity Type:Individual
Prefix:MRS
First Name:GINA
Middle Name:MARIA
Last Name:CANDELARIA
Suffix:
Gender:F
Credentials:MED MC LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:11771 E BECKER LN
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85259-4116
Mailing Address - Country:US
Mailing Address - Phone:480-332-7383
Mailing Address - Fax:480-451-1860
Practice Address - Street 1:9755 N 90TH ST
Practice Address - Street 2:SUITE 290
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85258-5046
Practice Address - Country:US
Practice Address - Phone:480-332-7383
Practice Address - Fax:480-451-1860
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLPC-10067101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional