Provider Demographics
NPI:1275101511
Name:ETHEREAL CONNECTEDNESS INC
Entity Type:Organization
Organization Name:ETHEREAL CONNECTEDNESS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/CEO
Authorized Official - Prefix:MS
Authorized Official - First Name:ACACIA
Authorized Official - Middle Name:
Authorized Official - Last Name:CHIDI
Authorized Official - Suffix:
Authorized Official - Credentials:LMFT
Authorized Official - Phone:510-759-2377
Mailing Address - Street 1:2323 BROADWAY
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94612-2414
Mailing Address - Country:US
Mailing Address - Phone:510-988-9878
Mailing Address - Fax:
Practice Address - Street 1:431 30TH ST STE 210E
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94609-3307
Practice Address - Country:US
Practice Address - Phone:510-988-9878
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-06-14
Last Update Date:2023-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty