Provider Demographics
NPI:1205250818
Name:BRILES, CANDACE HALL (MA, LCMHC)
Entity type:Individual
Prefix:
First Name:CANDACE
Middle Name:HALL
Last Name:BRILES
Suffix:
Gender:F
Credentials:MA, LCMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7721 HILBURN DR
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27613-4112
Mailing Address - Country:US
Mailing Address - Phone:919-234-5686
Mailing Address - Fax:919-234-5686
Practice Address - Street 1:7721 HILBURN DR
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27613-4112
Practice Address - Country:US
Practice Address - Phone:919-234-5686
Practice Address - Fax:919-234-5686
Is Sole Proprietor?:Yes
Enumeration Date:2014-02-18
Last Update Date:2020-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC13356101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional