Provider Demographics
NPI:1679298657
Name:DREXEL, CHASEN MARK (RADT-1)
Entity type:Individual
Prefix:MR
First Name:CHASEN
Middle Name:MARK
Last Name:DREXEL
Suffix:
Gender:M
Credentials:RADT-1
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1914 23RD ST
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95816-7113
Mailing Address - Country:US
Mailing Address - Phone:916-455-6258
Mailing Address - Fax:
Practice Address - Street 1:9012 EL CAJON WAY APT 2
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95826-3328
Practice Address - Country:US
Practice Address - Phone:916-579-8167
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-10-11
Last Update Date:2022-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAR1482680922101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)