1821496928 NPI number — SONYA B CHAMBLISS COUNSELING SERVICES

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1821496928 NPI number — SONYA B CHAMBLISS COUNSELING SERVICES

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SONYA B CHAMBLISS COUNSELING SERVICES
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1821496928
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/05/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
140 KAHANA RIDGE DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LAHAINA
Provider Business Mailing Address State Name:
HI
Provider Business Mailing Address Postal Code:
96761-8314
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
407-435-9926
Provider Business Mailing Address Fax Number:
808-442-1056

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
10 HOOHUI RD
Provider Second Line Business Practice Location Address:
STE 207
Provider Business Practice Location Address City Name:
LAHAINA
Provider Business Practice Location Address State Name:
HI
Provider Business Practice Location Address Postal Code:
96761-9256
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
808-250-9406
Provider Business Practice Location Address Fax Number:
808-442-1056
Provider Enumeration Date:
12/05/2014

Additional Information

Authorized Official

Authorized Official Last Name:
CHAMBLISS-ALEXANDER
Authorized Official First Name:
SONYA
Authorized Official Middle Name:
BETH
Authorized Official Title or Position:
OWNER/PROVIDER
Authorized Official Telephone Number:
407-435-9926

Provider Taxonomy Codes

  • Taxonomy code: 251S00000X , with the licence number:  LCSW 3861 , registered in the state of HI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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