Provider Demographics
NPI:1447496096
Name:CHUKWUEMEKA, VIVIAN (LCSW)
Entity type:Individual
Prefix:MRS
First Name:VIVIAN
Middle Name:
Last Name:CHUKWUEMEKA
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:MRS
Other - First Name:VIVIAN
Other - Middle Name:
Other - Last Name:CHUKWUEMEKA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LCSW
Mailing Address - Street 1:2736 WISTERIA LN
Mailing Address - Street 2:
Mailing Address - City:STOCKTON
Mailing Address - State:CA
Mailing Address - Zip Code:95212-2875
Mailing Address - Country:US
Mailing Address - Phone:626-208-7311
Mailing Address - Fax:
Practice Address - Street 1:1201 N SUTTER ST
Practice Address - Street 2:
Practice Address - City:STOCKTON
Practice Address - State:CA
Practice Address - Zip Code:95202-1506
Practice Address - Country:US
Practice Address - Phone:209-855-1006
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-01-05
Last Update Date:2021-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA960171041C0700X
171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No171M00000XOther Service ProvidersCase Manager/Care Coordinator