Provider Demographics
NPI:1912327537
Name:CHRYSALIS TO WINGS
Entity Type:Organization
Organization Name:CHRYSALIS TO WINGS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:FRANCINE
Authorized Official - Middle Name:
Authorized Official - Last Name:CARRIER-ZOREHKEY
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:949-916-6851
Mailing Address - Street 1:30021 TOMAS
Mailing Address - Street 2:SUITE 300
Mailing Address - City:RANCHO SANTA MARGARITA
Mailing Address - State:CA
Mailing Address - Zip Code:92688-2128
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:30021 TOMAS
Practice Address - Street 2:SUITE 300
Practice Address - City:RANCHO SANTA MARGARITA
Practice Address - State:CA
Practice Address - Zip Code:92688-2128
Practice Address - Country:US
Practice Address - Phone:949-916-6851
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-04-22
Last Update Date:2014-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA73287251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health