Healthcare Provider Details

I. General information

NPI: 1114701992
Provider Name (Legal Business Name): CHALNA BLAIR
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/22/2023
Last Update Date: 12/31/2024
Certification Date: 12/31/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1401 21ST ST STE 8122
SACRAMENTO CA
95811-5226
US

IV. Provider business mailing address

16 WATER ST
EVERETT PA
15537-1276
US

V. Phone/Fax

Practice location:
  • Phone: 805-910-7455
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: