Healthcare Provider Details

I. General information

NPI: 1588034250
Provider Name (Legal Business Name): CHERYL KOCHEVAR-NOLTE ASW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/06/2015
Last Update Date: 11/15/2023
Certification Date: 11/15/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

769 W BLAINE ST
RIVERSIDE CA
92507-3970
US

IV. Provider business mailing address

769 W BLAINE ST STE B
RIVERSIDE CA
92507-3970
US

V. Phone/Fax

Practice location:
  • Phone: 951-965-7180
  • Fax:
Mailing address:
  • Phone: 951-965-7180
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberASW97991
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: