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General NPI Number Information
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NPI Number | 1326398991
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Entity Type | Individual
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Provider Name | MS. JENISSA DAWN CHINTELLA
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Gender | Female
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Dates
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Enumeration Date | 09/11/2012
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Last Update Date | 12/11/2017
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Provider Practice Location Address
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Address Line | 4337 BLACKWOOD ST.
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City | NEWUBRY PARK
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State | CA
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Zip | 91320
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Country | US
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Telephone | 909-709-2459
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Fax |
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Provider Business Mailing Address
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Address Line | 165 HICKORY RIDGE WAY
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City | SUMMERVILLE
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State | SC
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Zip | 29483-9759
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Country | US
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Telephone | 909-709-2459
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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 | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number | 1488
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License Number State | SC
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