Provider Demographics
NPI:1922632017
Name:CHICHIBU, SAEKO
Entity Type:Individual
Prefix:
First Name:SAEKO
Middle Name:
Last Name:CHICHIBU
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 1:4286 COUNTRY SQUIRE LN
Mailing Address - Street 2:
Mailing Address - City:FAIRFAX
Mailing Address - State:VA
Mailing Address - Zip Code:22032-1610
Mailing Address - Country:US
Mailing Address - Phone:202-340-0801
Mailing Address - Fax:
Practice Address - Street 1:1425 UNIVERSITY BLVD E STE 245
Practice Address - Street 2:
Practice Address - City:HYATTSVILLE
Practice Address - State:MD
Practice Address - Zip Code:20783-4646
Practice Address - Country:US
Practice Address - Phone:202-340-0801
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-02-27
Last Update Date:2020-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLC9082101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health