Provider Demographics
NPI:1275391898
Name:FIGUEROA, CHANTELLE (LASAC)
Entity Type:Individual
Prefix:
First Name:CHANTELLE
Middle Name:
Last Name:FIGUEROA
Suffix:
Gender:F
Credentials:LASAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4621 S BAYPORT PL
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85730-5021
Mailing Address - Country:US
Mailing Address - Phone:520-549-8863
Mailing Address - Fax:
Practice Address - Street 1:6944 E TANQUE VERDE RD # RC
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85715-5308
Practice Address - Country:US
Practice Address - Phone:520-526-1000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-03-08
Last Update Date:2024-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ15448101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)