Provider Demographics
NPI:1083114706
Name:ARMSTRONG, CHAD PRINCE (R1371851119)
Entity Type:Individual
Prefix:
First Name:CHAD
Middle Name:PRINCE
Last Name:ARMSTRONG
Suffix:
Gender:M
Credentials:R1371851119
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2844 COLOMA ST
Mailing Address - Street 2:
Mailing Address - City:PLACERVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95667-4406
Mailing Address - Country:US
Mailing Address - Phone:530-642-1715
Mailing Address - Fax:530-642-2064
Practice Address - Street 1:2844 COLOMA ST
Practice Address - Street 2:
Practice Address - City:PLACERVILLE
Practice Address - State:CA
Practice Address - Zip Code:95667-4406
Practice Address - Country:US
Practice Address - Phone:530-642-1715
Practice Address - Fax:530-642-2064
Is Sole Proprietor?:No
Enumeration Date:2018-02-19
Last Update Date:2021-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
106S00000X, 106E00000X
CAR1371851119101YA0400X
CA00005178106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
No106E00000XBehavioral Health & Social Service ProvidersAssistant Behavior Analyst