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NPI Code Detail

MEDICARE: MRS. CANDICE MARIE HENDRICKSON LMFT

MEDICARE: MRS. CANDICE MARIE HENDRICKSON LMFT
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1106H00000XMarriage & Family Therapist49672CA

General Provider Information

NPI Number : 1992922561
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. CANDICE MARIE HENDRICKSON LMFT
Provider Business Mailing Address
First Line : 2271 ALPINE BLVD STE A
Second Line :
City : ALPINE
State : CA
Zip : 91901-1101
Country : US
Telephone Number : 888-688-0248
Fax Number : 888-291-4799
Provider Business Practice Location Address
First Line : 2271 ALPINE BLVD STE A
Second Line :
City : ALPINE
State : CA
Zip : 91901-1101
Country : US
Telephone Number : 888-688-0248
Fax Number : 888-291-4799
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/18/2007
Last Update Date : 12/11/2024

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