Provider Demographics
NPI:1003520313
Name:BRANCH, CHARESSE DEL SHAWNDRA
Entity Type:Individual
Prefix:
First Name:CHARESSE
Middle Name:DEL SHAWNDRA
Last Name:BRANCH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:CHARESSE
Other - Middle Name:DEL SHAWNDRA
Other - Last Name:COLLINS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:3154 DARKWOOD ST
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:CA
Mailing Address - Zip Code:93536-4727
Mailing Address - Country:US
Mailing Address - Phone:661-609-9147
Mailing Address - Fax:
Practice Address - Street 1:3154 DARKWOOD ST
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:CA
Practice Address - Zip Code:93536-4727
Practice Address - Country:US
Practice Address - Phone:661-609-9147
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-01-11
Last Update Date:2023-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA914741041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical