Healthcare Provider Details

I. General information

NPI: 1003210386
Provider Name (Legal Business Name): CHELSIA MICHELLE DURKEE ACSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/15/2014
Last Update Date: 10/27/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1007 N LAKE AVE
PASADENA CA
91104-4521
US

IV. Provider business mailing address

1030 W HUNTINGTON DR APT 24
ARCADIA CA
91007-8850
US

V. Phone/Fax

Practice location:
  • Phone: 626-808-9749
  • Fax:
Mailing address:
  • Phone: 510-407-4720
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberASW63149
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: