Healthcare Provider Details

I. General information

NPI: 1497067714
Provider Name (Legal Business Name): CHANTAE MONIQUE JAMES
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/02/2010
Last Update Date: 08/14/2026
Certification Date: 08/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1382 BLUE OAKS BLVD
ROSEVILLE CA
95678-7019
US

IV. Provider business mailing address

25778 7TH ST
SAN BERNARDINO CA
92410-4710
US

V. Phone/Fax

Practice location:
  • Phone: 951-400-5001
  • Fax:
Mailing address:
  • Phone: 951-400-5501
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number107414
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: