Provider Demographics
NPI:1568680569
Name:CEZERE, CHONDRELLE D (MED, LPCC)
Entity Type:Individual
Prefix:
First Name:CHONDRELLE
Middle Name:D
Last Name:CEZERE
Suffix:
Gender:F
Credentials:MED, LPCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11303 WILSHIRE BLVD
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90025-5069
Mailing Address - Country:US
Mailing Address - Phone:310-914-4045
Mailing Address - Fax:
Practice Address - Street 1:3580 WILSHIRE BLVD STE 2000
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90010-2533
Practice Address - Country:US
Practice Address - Phone:213-381-1250
Practice Address - Fax:213-383-4803
Is Sole Proprietor?:No
Enumeration Date:2007-04-23
Last Update Date:2022-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALPCC6393101YM0800X
LA3035101YP2500X
171M00000X
CA6393101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No171M00000XOther Service ProvidersCase Manager/Care Coordinator