Provider Demographics
NPI:1548335292
Name:FAGAN, CANDICE D (LCSW)
Entity type:Individual
Prefix:MRS
First Name:CANDICE
Middle Name:D
Last Name:FAGAN
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:317 N EL CAMINO REAL STE 305
Mailing Address - Street 2:
Mailing Address - City:ENCINITAS
Mailing Address - State:CA
Mailing Address - Zip Code:92024-2814
Mailing Address - Country:US
Mailing Address - Phone:760-436-1797
Mailing Address - Fax:760-753-0687
Practice Address - Street 1:317 N EL CAMINO REAL STE 305
Practice Address - Street 2:
Practice Address - City:ENCINITAS
Practice Address - State:CA
Practice Address - Zip Code:92024-2814
Practice Address - Country:US
Practice Address - Phone:760-436-1797
Practice Address - Fax:760-753-0687
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA41461041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical