Provider Demographics
NPI:1023198108
Name:CHIDICHIMO, WILLIAM C (LCSW)
Entity Type:Individual
Prefix:MR
First Name:WILLIAM
Middle Name:C
Last Name:CHIDICHIMO
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:MR
Other - First Name:BILL
Other - Middle Name:
Other - Last Name:CHIDICHIMO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LCSW
Mailing Address - Street 1:17TH MEDICAL OPERATIONS SQUADRON
Mailing Address - Street 2:271 FT RICHARDSON AVE
Mailing Address - City:GOODFELLOW AFB
Mailing Address - State:TX
Mailing Address - Zip Code:76908-4902
Mailing Address - Country:US
Mailing Address - Phone:325-654-3122
Mailing Address - Fax:
Practice Address - Street 1:17TH MEDICAL OPERATIONS SQUADRON
Practice Address - Street 2:271 FT RICHARDSON AVE
Practice Address - City:GOODFELLOW AFB
Practice Address - State:TX
Practice Address - Zip Code:76908-4902
Practice Address - Country:US
Practice Address - Phone:325-654-3122
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-16
Last Update Date:2007-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDLCSW-246491041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical