Provider Demographics
NPI:1720837735
Name:CHASE, ELVA (BCCC)
Entity type:Individual
Prefix:
First Name:ELVA
Middle Name:
Last Name:CHASE
Suffix:
Gender:F
Credentials:BCCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13720 OLD SAINT AUGUSTINE RD # 8-322
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32258-7414
Mailing Address - Country:US
Mailing Address - Phone:904-762-7959
Mailing Address - Fax:
Practice Address - Street 1:6155 CLEARSKY DR
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32258-8431
Practice Address - Country:US
Practice Address - Phone:904-762-7959
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-05-14
Last Update Date:2024-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health