Individual
CHANTAL KOA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
SSW, CASUDC
Contact information
Practice address
195 W 820 S UNIT 2, CEDAR CITY, UT 84720-3963
(435) 673-2899
(435) 359-5159
Mailing address
PO BOX 1131, CEDAR CITY, UT 84721-1101
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
10591268-6018
UT
104100000X
Social Worker
10591268-3503
UT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
00000
OTHER
—
Enumeration date
04/08/2022
Last updated
04/08/2024
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