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MR. MICHAEL LEE CHIDESTER CATC-I

Addiction (Substance Use Disorder) >> Counselor >> Behavioral Health & Social Service Providers

Registrant NPI Number: 1053973206

Individual Registrant:
MR. MICHAEL LEE CHIDESTER CATC-I
Gender: M
Sole Proprietor

Location and contact information for practice:
6330 THORNTON AVE  NEWARK, CA 94560-3734 US
Tel: 510-792-4357  Fax: --

Contact information for business:
6330 THORNTON AVE  NEWARK, CA 94560-3734 US
Tel: 510-792-4357  Fax: 510-745-1693

Registration Information:
NPI: 1053973206
Entity Type: Individual

Specialty information:

PrimaryCodeCategory/DescriptionStateLicense Number
Y101YA0400XBehavioral Health & Social Service Providers
Counselor
Addiction (Substance Use Disorder)

Legacy codes, insurance codes and state license numbers:

IssuerNumberStateType
SUD101YA0400XCA01




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