Provider Demographics
NPI:1841878923
Name:SEPULVEDA-MONACO, CANDICE DAWN (LCSW)
Entity type:Individual
Prefix:
First Name:CANDICE
Middle Name:DAWN
Last Name:SEPULVEDA-MONACO
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4755 CARNEGIE CT
Mailing Address - Street 2:
Mailing Address - City:CUMMING
Mailing Address - State:GA
Mailing Address - Zip Code:30028-2639
Mailing Address - Country:US
Mailing Address - Phone:770-713-7462
Mailing Address - Fax:
Practice Address - Street 1:4755 CARNEGIE CT
Practice Address - Street 2:
Practice Address - City:CUMMING
Practice Address - State:GA
Practice Address - Zip Code:30028-2639
Practice Address - Country:US
Practice Address - Phone:706-344-8462
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-03-31
Last Update Date:2021-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACSW0073281041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical