Provider Demographics
NPI:1306199336
Name:CHESSIN, SONIA MALKA (LAC, LCSW)
Entity Type:Individual
Prefix:MS
First Name:SONIA
Middle Name:MALKA
Last Name:CHESSIN
Suffix:
Gender:F
Credentials:LAC, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:301 W SUSSEX AVE
Mailing Address - Street 2:
Mailing Address - City:MISSOULA
Mailing Address - State:MT
Mailing Address - Zip Code:59801-6840
Mailing Address - Country:US
Mailing Address - Phone:406-370-5308
Mailing Address - Fax:
Practice Address - Street 1:301 W SUSSEX AVE
Practice Address - Street 2:
Practice Address - City:MISSOULA
Practice Address - State:MT
Practice Address - Zip Code:59801-6840
Practice Address - Country:US
Practice Address - Phone:406-370-5308
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-15
Last Update Date:2012-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT1245101YA0400X
MT10471041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)