Healthcare Provider Details

I. General information

NPI: 1689140808
Provider Name (Legal Business Name): CANDACE DRAKE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/15/2018
Last Update Date: 02/10/2025
Certification Date: 02/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6200 ROCKSIDE WOODS BLVD N
INDEPENDENCE OH
44131-2333
US

IV. Provider business mailing address

4000 WESTBROOK DR APT 222
BROOKLYN OH
44144-1249
US

V. Phone/Fax

Practice location:
  • Phone: 216-482-5749
  • Fax: 440-641-1170
Mailing address:
  • Phone: 216-482-5749
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: