Healthcare Provider Details

I. General information

NPI: 1386369643
Provider Name (Legal Business Name): SHALIN CANDELARIA LCMHC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/10/2022
Last Update Date: 04/24/2026
Certification Date: 04/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

990 VILLA ST
MOUNTAIN VIEW CA
94041-1236
US

IV. Provider business mailing address

5440 LEE FARM BLVD
CRESTVIEW FL
32536-5453
US

V. Phone/Fax

Practice location:
  • Phone: 888-688-9296
  • Fax:
Mailing address:
  • Phone: 910-483-5884
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberMH25496
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: