Individual provider Active NPI

Candice Marie Hendrickson, LMFT

  • Marriage & Family Therapist
  • Alpine, CA
National Provider Identifier
1992922561
Registry record updated Dec 11, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Marriage & Family TherapistTaxonomy code 106H00000X
License
49672 Issued in CA
Practice address
2271 Alpine Blvd Ste a
Alpine, CA 91901-1101
Phone
(888) 688-0248
Fax
(888) 291-4799
NPI assigned
Apr 18, 2007
Last updated
Dec 11, 2024By the provider in NPPES
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Dec 11, 2024

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Marriage & Family Therapist 106H00000X 49672 CA Primary

Addresses

Primary practice location

2271 Alpine Blvd Ste a
Alpine, CA 91901-1101

Mailing address

2271 Alpine Blvd Ste a
Alpine, CA 91901-1101
Phone (888) 688-0248

Other names 1

  • Miss Candice Marie Villarreal Former name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: No
  • Power mobility devices: No
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20240116002391 CA Practitioner - Marriage and Family Therapist 0345692315 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Marriage and Family Therapist
Education
Other, 2004
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

2271 Alpine Blvd
Suite a
Alpine, CA 91901-1101
Phone (619) 448-1216

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
49672CAMDGeneral Practice Dentistry

Practice roles

OrganizationSpecialtyStatusNew patients
Fusion Care Group, a Psychological Professional Corporation CurrentSince Jan 1, 2024 Accepting new patients

Locations

2271 Alpine Blvd
Ste A
Alpine, CA 91901
Phone (619) 289-7322

2124 S El Camino Real
Ste 101
Oceanside, CA 92054
Phone (760) 405-4787

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1176854400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1733875200000",
    "number": "1992922561",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2271 ALPINE BLVD STE A",
            "city": "ALPINE",
            "state": "CA",
            "postal_code": "919011101",
            "telephone_number": "888-688-0248",
            "fax_number": "888-291-4799"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2271 ALPINE BLVD STE A",
            "city": "ALPINE",
            "state": "CA",
            "postal_code": "919011101",
            "telephone_number": "888-688-0248",
            "fax_number": "888-291-4799"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HENDRICKSON",
        "first_name": "CANDICE",
        "middle_name": "MARIE",
        "name_prefix": "Mrs.",
        "credential": "LMFT",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2007-04-18",
        "last_updated": "2024-12-11",
        "certification_date": "2024-12-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "106H00000X",
            "taxonomy_group": "",
            "desc": "Marriage & Family Therapist",
            "state": "CA",
            "license": "49672",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "CANDICE",
            "last_name": "VILLARREAL",
            "middle_name": "MARIE",
            "prefix": "MISS",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Alpine, CA

Sources for this page

Verify at the official NPI Registry.