Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103K00000X | Behavior Analyst | 16-25569 |
NPI | 1003305285 |
---|---|
Provider Name | Candace Brooks |
First Address | Oakland, CA 94606-5227 |
Second Address | Oakland, CA 94606-5227 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/05/2018 |
Last Update Date | 03/05/2018 |