Provider Demographics
NPI:1104099928
Name:CHIN, CHERYL JULIE (MFT)
Entity type:Individual
Prefix:MRS
First Name:CHERYL
Middle Name:JULIE
Last Name:CHIN
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:MISS
Other - First Name:CHERYL
Other - Middle Name:JULIE
Other - Last Name:OLINSKY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MFT
Mailing Address - Street 1:6990 VILLAGE PKWY STE 201
Mailing Address - Street 2:
Mailing Address - City:DUBLIN
Mailing Address - State:CA
Mailing Address - Zip Code:94568
Mailing Address - Country:US
Mailing Address - Phone:408-674-2694
Mailing Address - Fax:
Practice Address - Street 1:6990 VILLAGE PKWY STE 201
Practice Address - Street 2:
Practice Address - City:DUBLIN
Practice Address - State:CA
Practice Address - Zip Code:94568-2423
Practice Address - Country:US
Practice Address - Phone:408-674-2694
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-13
Last Update Date:2019-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC 42846101YM0800X, 106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA6723Medicaid