Individual
MR. MICHAEL CHIPPOLLA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LCSW ACADC
Contact information
Practice address
4477 W EMERALD ST, BOISE, ID 83706-2000
(208) 713-5250
Mailing address
4477 W EMERALD ST, BOISE, ID 83706-2000
(208) 713-5250
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
ACADC-778
ID
1041C0700X
Clinical Social Worker
Primary
LCSW35126
ID
Other
Enumeration date
04/13/2015
Last updated
03/17/2017
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