Individual
CANDACE ENNIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
3556 EL CAMINO REAL, ATASCADERO, CA 93422-2532
(805) 461-6080
Mailing address
3556 EL CAMINO REAL, ATASCADERO, CA 93422-3556
(805) 461-6080
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
—
—
103K00000X
Behavior Analyst
—
—
Other
Enumeration date
08/02/2016
Last updated
03/08/2017
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