Provider Demographics
NPI:1184247249
Name:BROTHERTON, CANDICE YVONNE LEM (APCC)
Entity type:Individual
Prefix:MRS
First Name:CANDICE
Middle Name:YVONNE LEM
Last Name:BROTHERTON
Suffix:
Gender:F
Credentials:APCC
Other - Prefix:
Other - First Name:CANDICE
Other - Middle Name:YVONNE
Other - Last Name:LEM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:10486 ALTA LOMA DR
Mailing Address - Street 2:
Mailing Address - City:RANCHO CUCAMONGA
Mailing Address - State:CA
Mailing Address - Zip Code:91737-3847
Mailing Address - Country:US
Mailing Address - Phone:626-733-1204
Mailing Address - Fax:
Practice Address - Street 1:9479 HAVEN AVE
Practice Address - Street 2:
Practice Address - City:RANCHO CUCAMONGA
Practice Address - State:CA
Practice Address - Zip Code:91730-5844
Practice Address - Country:US
Practice Address - Phone:909-771-8023
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-05-24
Last Update Date:2020-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1497101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health