Provider Demographics
NPI:1811333891
Name:ROMERO, CANDACE GRACE (MA, LPC)
Entity type:Individual
Prefix:MRS
First Name:CANDACE
Middle Name:GRACE
Last Name:ROMERO
Suffix:
Gender:F
Credentials:MA, LPC
Other - Prefix:
Other - First Name:CANDACE
Other - Middle Name:GRACE
Other - Last Name:SMITH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA, LPC
Mailing Address - Street 1:7400 BLANCO RD STE 250
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78216-4368
Mailing Address - Country:US
Mailing Address - Phone:210-264-0785
Mailing Address - Fax:
Practice Address - Street 1:7400 BLANCO RD STE 250
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78216-4368
Practice Address - Country:US
Practice Address - Phone:210-264-0785
Practice Address - Fax:210-437-4774
Is Sole Proprietor?:Yes
Enumeration Date:2013-05-16
Last Update Date:2023-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX67917101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional