Provider Demographics
NPI:1770834822
Name:LAL, PRAVINA LEAH (LCSW)
Entity Type:Individual
Prefix:
First Name:PRAVINA
Middle Name:LEAH
Last Name:LAL
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:PRAVINA
Other - Middle Name:LEAH
Other - Last Name:LAL
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PRAVINA L LAL, LCSW
Mailing Address - Street 1:15 ILAHEE LN STE 100
Mailing Address - Street 2:
Mailing Address - City:CHICO
Mailing Address - State:CA
Mailing Address - Zip Code:95973-7205
Mailing Address - Country:US
Mailing Address - Phone:916-826-9288
Mailing Address - Fax:000-000-0000
Practice Address - Street 1:15 ILAHEE LN STE 100
Practice Address - Street 2:
Practice Address - City:CHICO
Practice Address - State:CA
Practice Address - Zip Code:95973
Practice Address - Country:US
Practice Address - Phone:916-826-9288
Practice Address - Fax:000-000-0000
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-28
Last Update Date:2020-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1041C0700X
CA36826104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical