Provider Demographics
NPI:1215581699
Name:CHOLLEY, MARIA L (LPC)
Entity Type:Individual
Prefix:
First Name:MARIA
Middle Name:L
Last Name:CHOLLEY
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:MARIA
Other - Middle Name:
Other - Last Name:PAMBLANCO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 5177
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85010-5177
Mailing Address - Country:US
Mailing Address - Phone:602-344-5651
Mailing Address - Fax:602-344-5578
Practice Address - Street 1:570 W BROWN RD
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85201-3227
Practice Address - Country:US
Practice Address - Phone:480-344-2258
Practice Address - Fax:480-344-0255
Is Sole Proprietor?:No
Enumeration Date:2019-07-24
Last Update Date:2019-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLPC-18212101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZPENDINGMedicaid