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General NPI Number Information
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NPI Number | 1104765825
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Entity Type | Organization
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Legal Business Name | CHRONICLES OF SUCCESS RECOVERY SERVICES LLC
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Dates
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Enumeration Date | 03/27/2026
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Last Update Date | 03/27/2026
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Provider Practice Location Address
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Address Line | 3140 JUANIPERO WAY STE 101
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City | MEDFORD
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State | OR
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Zip | 97504-8647
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Country | US
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Telephone | 541-323-4800
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Fax | 541-508-0330
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Provider Business Mailing Address
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Address Line | 3140 JUANIPERO WAY STE 101
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City | MEDFORD
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State | OR
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Zip | 97504-8647
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Country | US
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Telephone | 541-323-4800
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Fax | 541-508-0330
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Authorized Official
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Title or Position | ADMINISTRATIVE
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Name | AMBER CLAVECILLA
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Credential |
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Telephone | 678-276-9398
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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 |
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License Number State |
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