Provider Demographics
NPI:1891583415
Name:CABRAL, CANDYCE JULIA
Entity type:Individual
Prefix:
First Name:CANDYCE
Middle Name:JULIA
Last Name:CABRAL
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:CANDYCE
Other - Middle Name:J
Other - Last Name:HESTER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:7303 GRAND AVE APT 102
Mailing Address - Street 2:
Mailing Address - City:DOWNERS GROVE
Mailing Address - State:IL
Mailing Address - Zip Code:60516-4114
Mailing Address - Country:US
Mailing Address - Phone:312-863-0778
Mailing Address - Fax:
Practice Address - Street 1:2200 S MAIN ST STE 306
Practice Address - Street 2:
Practice Address - City:LOMBARD
Practice Address - State:IL
Practice Address - Zip Code:60148-5366
Practice Address - Country:US
Practice Address - Phone:630-290-0923
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-04-25
Last Update Date:2025-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL178021299101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health