Provider Demographics
NPI:1578633897
Name:CHIMA, OLABISI GRACE (PSYD)
Entity Type:Individual
Prefix:
First Name:OLABISI
Middle Name:GRACE
Last Name:CHIMA
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:612 S COCHRAN AVE APT 204
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90036-5910
Mailing Address - Country:US
Mailing Address - Phone:310-925-1063
Mailing Address - Fax:
Practice Address - Street 1:10605 BALBOA BLVD
Practice Address - Street 2:
Practice Address - City:GRANADA HILLS
Practice Address - State:CA
Practice Address - Zip Code:91344-6342
Practice Address - Country:US
Practice Address - Phone:818-832-2400
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY#17967103TC0700X
CARN370339163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Not Answered163W00000XNursing Service ProvidersRegistered Nurse