Healthcare Provider Details

I. General information

NPI: 1932064771
Provider Name (Legal Business Name): CANDICE GRANT LABA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/23/2025
Last Update Date: 08/20/2026
Certification Date: 08/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 W 9TH ST
FREDERICK MD
21701-4541
US

IV. Provider business mailing address

300 W 9TH ST
FREDERICK MD
21701-4541
US

V. Phone/Fax

Practice location:
  • Phone: 667-600-2199
  • Fax:
Mailing address:
  • Phone: 667-600-2199
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code106E00000X
TaxonomyAssistant Behavior Analyst
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberLGP18274
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: