Provider Demographics
NPI:1962754408
Name:MASON, CANDACE LEE (MA, LPC-S, NCC, CFRC)
Entity type:Individual
Prefix:
First Name:CANDACE
Middle Name:LEE
Last Name:MASON
Suffix:
Gender:F
Credentials:MA, LPC-S, NCC, CFRC
Other - Prefix:
Other - First Name:CANDACE
Other - Middle Name:LEE
Other - Last Name:JOHNSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:5815 BENT TREE DR
Mailing Address - Street 2:
Mailing Address - City:EAST LANSING
Mailing Address - State:MI
Mailing Address - Zip Code:48823-7789
Mailing Address - Country:US
Mailing Address - Phone:517-974-2402
Mailing Address - Fax:
Practice Address - Street 1:4460 OKEMOS RD STE 21
Practice Address - Street 2:
Practice Address - City:OKEMOS
Practice Address - State:MI
Practice Address - Zip Code:48864-2553
Practice Address - Country:US
Practice Address - Phone:517-974-2402
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-08
Last Update Date:2024-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6401013260101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional