Provider Demographics
NPI:1295283505
Name:HEWITT, CANDICE BRUCE
Entity type:Individual
Prefix:
First Name:CANDICE
Middle Name:BRUCE
Last Name:HEWITT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:CANDICE
Other - Middle Name:MARIE
Other - Last Name:BRUCE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:977 N DEWITT AVE
Mailing Address - Street 2:
Mailing Address - City:CLOVIS
Mailing Address - State:CA
Mailing Address - Zip Code:93611-7013
Mailing Address - Country:US
Mailing Address - Phone:562-472-8985
Mailing Address - Fax:
Practice Address - Street 1:1396 W HERNDON AVE
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93711-7126
Practice Address - Country:US
Practice Address - Phone:559-256-0100
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-09-15
Last Update Date:2024-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA116947104100000X
CA78020101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker