Provider Demographics
NPI:1780393314
Name:POTNURU, CHANDRA SEKHAR
Entity type:Individual
Prefix:
First Name:CHANDRA SEKHAR
Middle Name:
Last Name:POTNURU
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9146 E STOCKTON BLVD # 1039
Mailing Address - Street 2:
Mailing Address - City:ELK GROVE
Mailing Address - State:CA
Mailing Address - Zip Code:95624-9510
Mailing Address - Country:US
Mailing Address - Phone:916-870-8586
Mailing Address - Fax:916-236-3639
Practice Address - Street 1:225 30TH ST STE 311
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95816-3359
Practice Address - Country:US
Practice Address - Phone:916-870-8586
Practice Address - Fax:916-236-3639
Is Sole Proprietor?:Yes
Enumeration Date:2022-11-22
Last Update Date:2025-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALMFT152323106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Multi-Specialty