Provider Demographics
NPI:1376847624
Name:CHAMP, ANNA MARIE
Entity Type:Individual
Prefix:MRS
First Name:ANNA
Middle Name:MARIE
Last Name:CHAMP
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4944 E CLINTON WAY
Mailing Address - Street 2:STE. 101
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93727-1527
Mailing Address - Country:US
Mailing Address - Phone:559-251-4800
Mailing Address - Fax:559-455-5983
Practice Address - Street 1:4944 E CLINTON WAY
Practice Address - Street 2:STE. 101
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93727-1527
Practice Address - Country:US
Practice Address - Phone:559-251-4800
Practice Address - Fax:559-455-5983
Is Sole Proprietor?:No
Enumeration Date:2010-12-30
Last Update Date:2010-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health