Provider Demographics
NPI:1003145814
Name:KOLCHINS, JACQUELINE (LCSW)
Entity Type:Individual
Prefix:
First Name:JACQUELINE
Middle Name:
Last Name:KOLCHINS
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:JACQUELINE
Other - Middle Name:BETH
Other - Last Name:KOLCHINS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LCSW
Mailing Address - Street 1:26560 AGOURA RD
Mailing Address - Street 2:110-B
Mailing Address - City:CALABASAS
Mailing Address - State:CA
Mailing Address - Zip Code:91302-1926
Mailing Address - Country:US
Mailing Address - Phone:818-880-1260
Mailing Address - Fax:
Practice Address - Street 1:26560 AGOURA RD
Practice Address - Street 2:110-B
Practice Address - City:CALABASAS
Practice Address - State:CA
Practice Address - Zip Code:91302-1926
Practice Address - Country:US
Practice Address - Phone:818-880-1260
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-12-08
Last Update Date:2009-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCS193661041C0700X, 1041S0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No1041S0200XBehavioral Health & Social Service ProvidersSocial WorkerSchool