Provider Demographics
NPI:1467947903
Name:ANDERSON, CHICONIA (AMFT)
Entity Type:Individual
Prefix:MRS
First Name:CHICONIA
Middle Name:
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:AMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1678 SWEETLEAF LN
Mailing Address - Street 2:
Mailing Address - City:SIMI VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:93065-7431
Mailing Address - Country:US
Mailing Address - Phone:818-835-1268
Mailing Address - Fax:
Practice Address - Street 1:9713 S. SANTA MONICA BLVD #202
Practice Address - Street 2:
Practice Address - City:SIMI VALLEY
Practice Address - State:CA
Practice Address - Zip Code:93065-7431
Practice Address - Country:US
Practice Address - Phone:818-835-1268
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-06-27
Last Update Date:2018-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty