Organization
CHILD AND ADOLESCENT THERAPY
Active
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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