Healthcare Provider Details

I. General information

NPI: 1255052213
Provider Name (Legal Business Name): CANDICE OLIVIA CRAFT LMFT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/08/2022
Last Update Date: 03/28/2026
Certification Date: 03/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

900 E MAIN ST STE 350
GRASS VALLEY CA
95945-5853
US

IV. Provider business mailing address

PO BOX 3512
GRASS VALLEY CA
95945-3500
US

V. Phone/Fax

Practice location:
  • Phone: 530-362-4163
  • Fax:
Mailing address:
  • Phone: 530-362-4163
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number154305
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: