Healthcare Provider Details

I. General information

NPI: 1013692722
Provider Name (Legal Business Name): ALLEN CHOI LCSW
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/20/2023
Last Update Date: 06/20/2023
Certification Date: 06/20/2023
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: 510-823-9069
  • Fax:
Mailing address:
  • Phone: 510-823-9069
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number111175
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number111175
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: