Provider Demographics
NPI:1861134454
Name:CANDELARIA, COURTNEY NICHOLE
Entity type:Individual
Prefix:
First Name:COURTNEY
Middle Name:NICHOLE
Last Name:CANDELARIA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:COURTNEY
Other - Middle Name:NICHOLE
Other - Last Name:GIBBS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1100 PEDRAS RD APT C131
Mailing Address - Street 2:
Mailing Address - City:TURLOCK
Mailing Address - State:CA
Mailing Address - Zip Code:95382-2332
Mailing Address - Country:US
Mailing Address - Phone:951-375-9699
Mailing Address - Fax:
Practice Address - Street 1:3195 M ST
Practice Address - Street 2:
Practice Address - City:MERCED
Practice Address - State:CA
Practice Address - Zip Code:95348-2406
Practice Address - Country:US
Practice Address - Phone:209-668-9361
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-04-13
Last Update Date:2022-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No104100000XBehavioral Health & Social Service ProvidersSocial Worker
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist