Provider Demographics
NPI:1881484392
Name:LENTZ, CANDICE GAIL
Entity type:Individual
Prefix:
First Name:CANDICE
Middle Name:GAIL
Last Name:LENTZ
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5350 OLD REDWOOD HWY
Mailing Address - Street 2:SUITE 600
Mailing Address - City:PETALUMA
Mailing Address - State:CA
Mailing Address - Zip Code:94954
Mailing Address - Country:US
Mailing Address - Phone:707-565-6647
Mailing Address - Fax:
Practice Address - Street 1:5350 OLD REDWOOD HWY
Practice Address - Street 2:SUITE 600
Practice Address - City:PETALUMA
Practice Address - State:CA
Practice Address - Zip Code:94954
Practice Address - Country:US
Practice Address - Phone:707-565-6647
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-05-08
Last Update Date:2025-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health