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General NPI Number Information
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NPI Number | 1891583415
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Entity Type | Individual
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Provider Name | CANDYCE JULIA CABRAL
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Gender | Female
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Dates
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Enumeration Date | 04/25/2025
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Last Update Date | 04/25/2025
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Provider Practice Location Address
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Address Line | 2200 S MAIN ST STE 306
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City | LOMBARD
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State | IL
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Zip | 60148-5366
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Country | US
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Telephone | 630-290-0923
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Fax |
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Provider Business Mailing Address
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Address Line | 7303 GRAND AVE APT 102
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City | DOWNERS GROVE
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State | IL
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Zip | 60516-4114
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Country | US
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Telephone | 312-863-0778
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 178021299
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License Number State | IL
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