Provider Demographics
NPI:1962854687
Name:WHITE-LEACH, CHALEEN
Entity Type:Individual
Prefix:
First Name:CHALEEN
Middle Name:
Last Name:WHITE-LEACH
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 1:1342 E 27TH ST
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94606-3266
Mailing Address - Country:US
Mailing Address - Phone:510-535-0611
Mailing Address - Fax:510-535-1658
Practice Address - Street 1:1342 E 27TH ST
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94606-3266
Practice Address - Country:US
Practice Address - Phone:510-535-0611
Practice Address - Fax:510-535-1658
Is Sole Proprietor?:No
Enumeration Date:2016-07-06
Last Update Date:2016-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA#5339101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)