Provider Demographics
NPI:1366652497
Name:SLAVONIC, CHANDRA DIANA (MFT)
Entity Type:Individual
Prefix:
First Name:CHANDRA
Middle Name:DIANA
Last Name:SLAVONIC
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2403 PROFESSIONAL DR
Mailing Address - Street 2:SUITE 101
Mailing Address - City:SANTA ROSA
Mailing Address - State:CA
Mailing Address - Zip Code:95403-3007
Mailing Address - Country:US
Mailing Address - Phone:707-544-3295
Mailing Address - Fax:707-544-9011
Practice Address - Street 1:2403 PROFESSIONAL DR
Practice Address - Street 2:SUITE 101
Practice Address - City:SANTA ROSA
Practice Address - State:CA
Practice Address - Zip Code:95403-3007
Practice Address - Country:US
Practice Address - Phone:707-544-3295
Practice Address - Fax:707-544-9011
Is Sole Proprietor?:No
Enumeration Date:2007-05-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA32746106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist