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General NPI Number Information
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NPI Number | 1477291656
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Entity Type | Individual
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Provider Name | THOMAS CHEVOLEK IV SUDCC
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Gender | Male
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Dates
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Enumeration Date | 05/26/2022
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Last Update Date | 07/07/2025
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Provider Practice Location Address
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Address Line | 104 W 4TH ST
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City | SAN BERNARDINO
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State | CA
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Zip | 92415-0035
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Country | US
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Telephone | 909-756-1027
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Fax |
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Provider Business Mailing Address
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Address Line | 6085 FALLING TREE LN
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City | ALTA LOMA
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State | CA
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Zip | 91737-2817
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Country | US
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Telephone |
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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 | 21793
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License Number State | CA
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