Provider Demographics
NPI:1568294692
Name:LEE, CANDICE ARTELIA
Entity type:Individual
Prefix:MS
First Name:CANDICE
Middle Name:ARTELIA
Last Name:LEE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1418 WATERSIDE VILLAGE DR
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:TX
Mailing Address - Zip Code:77407-6952
Mailing Address - Country:US
Mailing Address - Phone:361-212-8362
Mailing Address - Fax:
Practice Address - Street 1:1418 WATERSIDE VILLAGE DR
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:TX
Practice Address - Zip Code:77407-6952
Practice Address - Country:US
Practice Address - Phone:361-212-8362
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-08-16
Last Update Date:2024-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXRBT-24-323841106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician