Provider Demographics
NPI:1619119104
Name:ARNOLD, CHAD M (MFC)
Entity Type:Individual
Prefix:
First Name:CHAD
Middle Name:M
Last Name:ARNOLD
Suffix:
Gender:M
Credentials:MFC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1094 CUDAHY PLACE
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92110-3931
Mailing Address - Country:US
Mailing Address - Phone:619-275-0822
Mailing Address - Fax:619-276-8230
Practice Address - Street 1:1094 CUDAHY PL
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92110-3931
Practice Address - Country:US
Practice Address - Phone:619-275-0822
Practice Address - Fax:619-276-8230
Is Sole Proprietor?:Yes
Enumeration Date:2009-03-30
Last Update Date:2011-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC 28893106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAMFC 28893OtherLICENSE NUMBER