Provider Demographics
NPI:1649164161
Name:BROOKS, CANDACE T
Entity type:Individual
Prefix:
First Name:CANDACE
Middle Name:T
Last Name:BROOKS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21741 HILLSIDE DR APT C2
Mailing Address - Street 2:
Mailing Address - City:CLINTON TWP
Mailing Address - State:MI
Mailing Address - Zip Code:48035-6016
Mailing Address - Country:US
Mailing Address - Phone:586-303-8851
Mailing Address - Fax:586-303-8851
Practice Address - Street 1:21741 HILLSIDE DR APT C2
Practice Address - Street 2:
Practice Address - City:CLINTON TWP
Practice Address - State:MI
Practice Address - Zip Code:48035-6016
Practice Address - Country:US
Practice Address - Phone:586-303-8851
Practice Address - Fax:586-303-8851
Is Sole Proprietor?:Yes
Enumeration Date:2025-06-09
Last Update Date:2025-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care