Healthcare Provider Details

I. General information

NPI: 1730940297
Provider Name (Legal Business Name): CHOI LICENSED CLINICAL SOCIAL WORKER & NISHIMI CHILD THERAPIST
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/22/2024
Last Update Date: 05/31/2024
Certification Date: 05/31/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1844 SAN MIGUEL DR STE 306A
WALNUT CREEK CA
94596-8610
US

IV. Provider business mailing address

1844 SAN MIGUEL DR STE 306A
WALNUT CREEK CA
94596-8610
US

V. Phone/Fax

Practice location:
  • Phone: 925-289-8025
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number State

VIII. Authorized Official

Name: ANDREA NISHIMI
Title or Position: CO-FOUNDER
Credential:
Phone: 925-289-8025