Provider Demographics
NPI:1538405816
Name:STEPHENS, CANDACE IRENE GUILLORY (MS, LMHC, ATR)
Entity type:Individual
Prefix:
First Name:CANDACE
Middle Name:IRENE GUILLORY
Last Name:STEPHENS
Suffix:
Gender:F
Credentials:MS, LMHC, ATR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3747 RIVERWOOD DR
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46214-4030
Mailing Address - Country:US
Mailing Address - Phone:850-320-4110
Mailing Address - Fax:
Practice Address - Street 1:980 INDIANA AVE FL 2
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46202-2915
Practice Address - Country:US
Practice Address - Phone:317-274-2548
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-12-14
Last Update Date:2025-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
IN39003470A101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health