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General NPI Number Information
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NPI Number | 1104696038
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Entity Type | Individual
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Provider Name | JAIME CHAPMAN
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Gender | Female
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Dates
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Enumeration Date | 01/02/2024
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Last Update Date | 03/29/2024
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Provider Practice Location Address
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Address Line | 540 MIDDLE RINCON RD
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City | SANTA ROSA
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State | CA
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Zip | 95409-3107
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Country | US
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Telephone | 707-228-7667
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Fax |
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Provider Business Mailing Address
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Address Line | 4934 SUNSHINE AVE
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City | SANTA ROSA
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State | CA
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Zip | 95409-2660
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Country | US
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Telephone | 916-968-5048
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | 490047AN
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License Number State | CA
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