Provider Demographics
NPI:1528357860
Name:CHISOM, TRANINE DENNAE
Entity Type:Individual
Prefix:
First Name:TRANINE
Middle Name:DENNAE
Last Name:CHISOM
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:TRANINE
Other - Middle Name:DENNAE
Other - Last Name:BOWEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:902 TUOLUMNE ST
Mailing Address - Street 2:
Mailing Address - City:VALLEJO
Mailing Address - State:CA
Mailing Address - Zip Code:94590-4641
Mailing Address - Country:US
Mailing Address - Phone:707-425-7036
Mailing Address - Fax:707-425-3630
Practice Address - Street 1:201 E ALASKA AVE # 9
Practice Address - Street 2:
Practice Address - City:FAIRFIELD
Practice Address - State:CA
Practice Address - Zip Code:94533-7333
Practice Address - Country:US
Practice Address - Phone:707-425-7036
Practice Address - Fax:707-425-3630
Is Sole Proprietor?:No
Enumeration Date:2011-04-06
Last Update Date:2011-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health