Provider Demographics
NPI:1821803107
Name:CHAVARRIA, MICHAEL RALPH JR (MA W/PPS CREDENTIAL)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:RALPH
Last Name:CHAVARRIA
Suffix:JR
Gender:M
Credentials:MA W/PPS CREDENTIAL
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1663 N RIPON RD UNIT 301
Mailing Address - Street 2:
Mailing Address - City:RIPON
Mailing Address - State:CA
Mailing Address - Zip Code:95366-9822
Mailing Address - Country:US
Mailing Address - Phone:209-675-3880
Mailing Address - Fax:
Practice Address - Street 1:3601 KOHNEN WAY
Practice Address - Street 2:
Practice Address - City:DUBLIN
Practice Address - State:CA
Practice Address - Zip Code:94568-8751
Practice Address - Country:US
Practice Address - Phone:925-875-9376
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-02-12
Last Update Date:2025-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA240229854101YS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YS0200XBehavioral Health & Social Service ProvidersCounselorSchool