Provider Demographics
NPI:1619768736
Name:ALCHEMICAL COUNSELING SERVICES LICENSED CLINICAL SOCIAL WORKER, INC
Entity type:Organization
Organization Name:ALCHEMICAL COUNSELING SERVICES LICENSED CLINICAL SOCIAL WORKER, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO, CFO, SECRETARY
Authorized Official - Prefix:
Authorized Official - First Name:EILEEN
Authorized Official - Middle Name:
Authorized Official - Last Name:EVIND
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:707-800-5788
Mailing Address - Street 1:100 E ST STE 320
Mailing Address - Street 2:
Mailing Address - City:SANTA ROSA
Mailing Address - State:CA
Mailing Address - Zip Code:95404-4607
Mailing Address - Country:US
Mailing Address - Phone:707-800-5788
Mailing Address - Fax:
Practice Address - Street 1:100 E ST STE 320
Practice Address - Street 2:
Practice Address - City:SANTA ROSA
Practice Address - State:CA
Practice Address - Zip Code:95404-4607
Practice Address - Country:US
Practice Address - Phone:707-800-5788
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-05-16
Last Update Date:2025-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty