Provider Demographics
NPI:1902033889
Name:LOCKRIDGE WEIGEL, CHANTEL NIKOLE (MFTT)
Entity type:Individual
Prefix:
First Name:CHANTEL
Middle Name:NIKOLE
Last Name:LOCKRIDGE WEIGEL
Suffix:
Gender:F
Credentials:MFTT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:176 44TH AVE
Mailing Address - Street 2:
Mailing Address - City:SAN MATEO
Mailing Address - State:CA
Mailing Address - Zip Code:94403-5116
Mailing Address - Country:US
Mailing Address - Phone:619-481-0862
Mailing Address - Fax:
Practice Address - Street 1:225 CABRILLO HWY S STE 200A
Practice Address - Street 2:
Practice Address - City:HALF MOON BAY
Practice Address - State:CA
Practice Address - Zip Code:94019-7210
Practice Address - Country:US
Practice Address - Phone:650-726-6369
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-06-17
Last Update Date:2009-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist