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Organization

CHILD AND ADOLESCENT THERAPY

Active
Organization subpart
No

Provider details

NPI number
Authorized official
CANDICE RENE SANBORN LISW-S (OWNER)
(216) 551-7595
Entity
Organization

Contact information

Practice address
30400 DETROIT RD STE 301, WESTLAKE, OH 44145-1855
(216) 551-7595
Mailing address
20588 LORAIN RD APT 14, FAIRVIEW PARK, OH 44126-3466
(216) 551-7595

Taxonomy

Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
1302314-SUPV
OH

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
0222497
OH
Enumeration date
07/16/2018
Last updated
07/16/2018
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