Basic Information
| Provider Information | |||||||||
| NPI: | 1477755445 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | CARMICHAEL | ||||||||
| FirstName: | CHRIS | ||||||||
| MiddleName: | |||||||||
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| Credential: | M.A. | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 15 | ||||||||
| Address2: | |||||||||
| City: | VILLA GRANDE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 954860015 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5106846028 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 4368 LINCOLN AVE | ||||||||
| Address2: | |||||||||
| City: | OAKLAND | ||||||||
| State: | CA | ||||||||
| PostalCode: | 946022529 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5105313111 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/01/2007 | ||||||||
| LastUpdateDate: | 09/30/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 09/30/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101Y00000X | N | Behavioral Health & Social Service Providers | Counselor | 1041C0700X | 109665 | CA | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No ID Information.