Provider Demographics
NPI:1629753694
Name:DUDLEY, CHASITY KIARA
Entity Type:Individual
Prefix:
First Name:CHASITY
Middle Name:KIARA
Last Name:DUDLEY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1945 N BLOOM DR
Mailing Address - Street 2:
Mailing Address - City:COMPTON
Mailing Address - State:CA
Mailing Address - Zip Code:90222-1049
Mailing Address - Country:US
Mailing Address - Phone:562-552-0336
Mailing Address - Fax:
Practice Address - Street 1:13135 BARTON RD STE ABC
Practice Address - Street 2:
Practice Address - City:WHITTIER
Practice Address - State:CA
Practice Address - Zip Code:90605-2757
Practice Address - Country:US
Practice Address - Phone:562-944-2794
Practice Address - Fax:562-944-6415
Is Sole Proprietor?:No
Enumeration Date:2023-06-19
Last Update Date:2023-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106E00000XBehavioral Health & Social Service ProvidersAssistant Behavior Analyst