| Ethereal Connectedness Inc | |
|
431 30th St Ste 210e Oakland CA 94609-3307 | |
| (510) 988-9878 | |
| Not Available |
| Full Name | Ethereal Connectedness Inc |
|---|---|
| Speciality | Marriage & Family Therapist |
| Location | 431 30th St Ste 210e, Oakland, California |
| Authorized Official Name and Position | Acacia Chidi (OWNER/CEO) |
| Authorized Official Contact | 5107592377 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Ethereal Connectedness Inc 2323 Broadway Oakland CA 94612-2414 Ph: (510) 988-9878 | Ethereal Connectedness Inc 431 30th St Ste 210e Oakland CA 94609-3307 Ph: (510) 988-9878 |
| NPI Number | 1275101511 |
|---|---|
| Provider Enumeration Date | 06/14/2021 |
| Last Update Date | 07/23/2023 |
| Certification Date | 07/23/2023 |
| Medicare PECOS PAC ID | 7315384179 |
|---|---|
| Medicare Enrollment ID | O20240328001699 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1275101511 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 106H00000X | Marriage & Family Therapist | (* (Not Available)) | Primary |
| Provider Name | Acacia Hasina Chidi |
|---|---|
| Provider Type | Practitioner - Marriage And Family Therapist |
| Provider Identifiers | NPI Number: 1528465903 PECOS PAC ID: 9133566995 Enrollment ID: I20240328001756 |
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