Healthcare Provider Details

I. General information

NPI: 1174130280
Provider Name (Legal Business Name): CANDREA DAVIES LCPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/23/2020
Last Update Date: 07/27/2026
Certification Date: 07/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6800 WISCONSIN AVE
CHEVY CHASE MD
20815-6105
US

IV. Provider business mailing address

2659 STATE ST STE 1012
CARLSBAD CA
92008-1627
US

V. Phone/Fax

Practice location:
  • Phone: 855-917-8732
  • Fax:
Mailing address:
  • Phone: 855-917-8732
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberLC11440
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: