Provider Demographics
NPI:1043087380
Name:CHACON, ELIZABETH JOANNA
Entity type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:JOANNA
Last Name:CHACON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:908 SALISBURY GRN
Mailing Address - Street 2:
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23452-6123
Mailing Address - Country:US
Mailing Address - Phone:757-406-7397
Mailing Address - Fax:
Practice Address - Street 1:35 NE 197TH AVE
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97230-8006
Practice Address - Country:US
Practice Address - Phone:503-473-1876
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-12-06
Last Update Date:2023-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORIN-10235061106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician