Healthcare Provider Details

I. General information

NPI: 1376478818
Provider Name (Legal Business Name): CANDICE KIMBELL TRAINING & CONSULTING
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/16/2026
Last Update Date: 06/16/2026
Certification Date: 06/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1042 N TURNER AVE APT 213
ONTARIO CA
91764-5357
US

IV. Provider business mailing address

473 E CARNEGIE DR STE 200
SAN BERNARDINO CA
92408-4201
US

V. Phone/Fax

Practice location:
  • Phone: 909-480-1894
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number State

VIII. Authorized Official

Name: CANDICE KIMBELL-AWOLEYE
Title or Position: CHEIF EXECUTIVE OFFICER
Credential: LCSW
Phone: 909-480-1894