Provider Demographics
NPI:1396139804
Name:PRINCIPE, AIRA SAMANTHA CHING (LCSW)
Entity type:Individual
Prefix:MS
First Name:AIRA SAMANTHA
Middle Name:CHING
Last Name:PRINCIPE
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:AIRA SAMANTHA
Other - Middle Name:MARI
Other - Last Name:CHING
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 15542
Mailing Address - Street 2:
Mailing Address - City:ANAHEIM
Mailing Address - State:CA
Mailing Address - Zip Code:92803-5542
Mailing Address - Country:US
Mailing Address - Phone:949-329-3615
Mailing Address - Fax:
Practice Address - Street 1:19712 MACARTHUR BLVD
Practice Address - Street 2:
Practice Address - City:IRVINE
Practice Address - State:CA
Practice Address - Zip Code:92612-2407
Practice Address - Country:US
Practice Address - Phone:949-329-3615
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-03-23
Last Update Date:2023-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA83028101YM0800X
102906101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health