Basic Information
| Provider Information | |||||||||
| NPI: | 1003017930 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | CHAFFIN | ||||||||
| FirstName: | ALEISHA | ||||||||
| MiddleName: | BOODOIAN | ||||||||
| NamePrefix: | |||||||||
| NameSuffix: | |||||||||
| Credential: | LPC | ||||||||
| OtherOrganizationName: | |||||||||
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| Mailing Information | |||||||||
| Address1: | 212 BOB WALLACE AVENUE | ||||||||
| Address2: | |||||||||
| City: | HUNTSVILLE | ||||||||
| State: | AL | ||||||||
| PostalCode: | 358016444 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2568082522 | ||||||||
| FaxNumber: | 2568082523 | ||||||||
| Practice Location | |||||||||
| Address1: | 212 BOB WALLACE AVENUE | ||||||||
| Address2: | |||||||||
| City: | HUNTSVILLE | ||||||||
| State: | AL | ||||||||
| PostalCode: | 358016444 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2568082522 | ||||||||
| FaxNumber: | 2568082523 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/29/2007 | ||||||||
| LastUpdateDate: | 02/01/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 02/01/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101Y00000X | 3050 | AL | Y | Behavioral Health & Social Service Providers | Counselor |
No ID Information.