Provider Demographics
NPI:1003576224
Name:CHAPARRAL COUNSELING, LICENSED CLINICAL SOCIAL WORKER, PC
Entity Type:Organization
Organization Name:CHAPARRAL COUNSELING, LICENSED CLINICAL SOCIAL WORKER, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:FIONA C.
Authorized Official - Middle Name:
Authorized Official - Last Name:LUNDY
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:510-971-0799
Mailing Address - Street 1:2100 LAKESHORE AVE STE C
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94606-1188
Mailing Address - Country:US
Mailing Address - Phone:510-971-0799
Mailing Address - Fax:
Practice Address - Street 1:2100 LAKESHORE AVE STE C
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94606-1188
Practice Address - Country:US
Practice Address - Phone:510-971-0799
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-12-29
Last Update Date:2021-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty