Healthcare Provider Details

I. General information

NPI: 1255613337
Provider Name (Legal Business Name): CANDACE DAWN SEXTON CUDD LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: CANDACE DAWN SEXTON

II. Dates (important events)

Enumeration Date: 09/14/2011
Last Update Date: 06/19/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2118 GRAND BLVD
PEARLAND TX
77581-3402
US

IV. Provider business mailing address

13615 SAINT MARYS LN
HOUSTON TX
77079-3439
US

V. Phone/Fax

Practice location:
  • Phone: 281-660-0327
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number62799
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: