Provider Demographics
NPI:1982727947
Name:GOUDEAU, CANDACE Y
Entity Type:Individual
Prefix:
First Name:CANDACE
Middle Name:Y
Last Name:GOUDEAU
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 1:900 S BEACH BLVD
Mailing Address - Street 2:#126
Mailing Address - City:ANAHEIM
Mailing Address - State:CA
Mailing Address - Zip Code:92804-3936
Mailing Address - Country:US
Mailing Address - Phone:323-528-0965
Mailing Address - Fax:323-249-8367
Practice Address - Street 1:11905 S CENTRAL AVE
Practice Address - Street 2:SUITE 205
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90059-2836
Practice Address - Country:US
Practice Address - Phone:323-249-9026
Practice Address - Fax:323-249-8367
Is Sole Proprietor?:No
Enumeration Date:2007-04-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CACAS#4488101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)