Provider Demographics
NPI:1811581127
Name:GOULD, CHELSEA R (SUDRC)
Entity Type:Individual
Prefix:
First Name:CHELSEA
Middle Name:R
Last Name:GOULD
Suffix:
Gender:F
Credentials:SUDRC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5049 MESA RIDGE DR
Mailing Address - Street 2:
Mailing Address - City:ANTIOCH
Mailing Address - State:CA
Mailing Address - Zip Code:94531-8007
Mailing Address - Country:US
Mailing Address - Phone:925-435-8801
Mailing Address - Fax:
Practice Address - Street 1:2 DAVI AVE
Practice Address - Street 2:
Practice Address - City:PITTSBURG
Practice Address - State:CA
Practice Address - Zip Code:94565-3701
Practice Address - Country:US
Practice Address - Phone:925-427-1384
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-02-26
Last Update Date:2021-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA11172101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)