Provider Demographics
NPI:1992922561
Name:HENDRICKSON, CANDICE MARIE (LMFT)
Entity type:Individual
Prefix:MRS
First Name:CANDICE
Middle Name:MARIE
Last Name:HENDRICKSON
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:MISS
Other - First Name:CANDICE
Other - Middle Name:MARIE
Other - Last Name:VILLARREAL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2271 ALPINE BLVD STE A
Mailing Address - Street 2:
Mailing Address - City:ALPINE
Mailing Address - State:CA
Mailing Address - Zip Code:91901-1101
Mailing Address - Country:US
Mailing Address - Phone:888-688-0248
Mailing Address - Fax:888-291-4799
Practice Address - Street 1:2271 ALPINE BLVD STE A
Practice Address - Street 2:
Practice Address - City:ALPINE
Practice Address - State:CA
Practice Address - Zip Code:91901-1101
Practice Address - Country:US
Practice Address - Phone:888-688-0248
Practice Address - Fax:888-291-4799
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-18
Last Update Date:2024-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA49672106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist