Healthcare Provider Details

I. General information

NPI: 1821449638
Provider Name (Legal Business Name): CANDICE L CARR MS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/23/2016
Last Update Date: 04/10/2026
Certification Date: 04/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1015 RHODE ISLAND ST
SAN FRANCISCO CA
94107-3214
US

IV. Provider business mailing address

650 S GAINES ST APT 1910
PORTLAND OR
97239-4771
US

V. Phone/Fax

Practice location:
  • Phone: 415-599-0988
  • Fax:
Mailing address:
  • Phone: 323-363-6570
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number92953
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: