Provider Demographics
NPI:1487406351
Name:CHILTON, ANDREA (MFT)
Entity type:Individual
Prefix:
First Name:ANDREA
Middle Name:
Last Name:CHILTON
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:449 BLAKE CT
Mailing Address - Street 2:
Mailing Address - City:ARCATA
Mailing Address - State:CA
Mailing Address - Zip Code:95521-6808
Mailing Address - Country:US
Mailing Address - Phone:415-310-5652
Mailing Address - Fax:
Practice Address - Street 1:449 BLAKE CT
Practice Address - Street 2:
Practice Address - City:ARCATA
Practice Address - State:CA
Practice Address - Zip Code:95521-6808
Practice Address - Country:US
Practice Address - Phone:415-310-5652
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-04-03
Last Update Date:2024-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA50103106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist