Basic Information
| Provider Information | |||||||||
| NPI: | 1912033747 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | CHALI | ||||||||
| FirstName: | COLLEEN | ||||||||
| MiddleName: | NOMSA | ||||||||
| NamePrefix: | MRS. | ||||||||
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| Credential: | LCSW | ||||||||
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| Mailing Information | |||||||||
| Address1: | 357 W 2ND ST STE 3 | ||||||||
| Address2: | |||||||||
| City: | SAN BERNARDINO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 924011803 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9099363888 | ||||||||
| FaxNumber: | 9096356173 | ||||||||
| Practice Location | |||||||||
| Address1: | 1669 N E ST | ||||||||
| Address2: | |||||||||
| City: | SAN BERNARDINO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 924054405 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9098866737 | ||||||||
| FaxNumber: | 9098813871 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/26/2007 | ||||||||
| LastUpdateDate: | 06/11/2018 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041C0700X | LCSW29187 | CA | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No ID Information.