Provider Demographics
NPI:1720581077
Name:CHAVARRIA-AGUILAR, SANDRA ELIZABETH (MA LPCC)
Entity Type:Individual
Prefix:MISS
First Name:SANDRA
Middle Name:ELIZABETH
Last Name:CHAVARRIA-AGUILAR
Suffix:
Gender:F
Credentials:MA LPCC
Other - Prefix:MISS
Other - First Name:SANDRA
Other - Middle Name:ELIZABETH
Other - Last Name:CHAVARRIA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:2000 W BRIGGSMORE AVE STE I
Mailing Address - Street 2:
Mailing Address - City:MODESTO
Mailing Address - State:CA
Mailing Address - Zip Code:95350-3839
Mailing Address - Country:US
Mailing Address - Phone:209-526-1476
Mailing Address - Fax:209-526-0908
Practice Address - Street 1:2000 W BRIGGSMORE AVE STE I
Practice Address - Street 2:
Practice Address - City:MODESTO
Practice Address - State:CA
Practice Address - Zip Code:95350-3839
Practice Address - Country:US
Practice Address - Phone:209-526-1476
Practice Address - Fax:209-526-0908
Is Sole Proprietor?:No
Enumeration Date:2018-03-13
Last Update Date:2024-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAPCC5779101YP2500X
390200000X
CALPCC16087101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program