Healthcare Provider Details

I. General information

NPI: 1912744269
Provider Name (Legal Business Name): ROSE ELIA CHAHLA LPCC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/12/2024
Last Update Date: 03/07/2026
Certification Date: 03/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2930 DOMINGO AVE # 1054
BERKELEY CA
94705-2454
US

IV. Provider business mailing address

2930 DOMINGO AVE # 1054
BERKELEY CA
94705-2454
US

V. Phone/Fax

Practice location:
  • Phone: 925-255-5271
  • Fax:
Mailing address:
  • Phone: 925-255-5271
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number21776
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: