Individual
CHRIS MICHAEL PACKHAM
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LAADC, WTS, CS
Contact information
Practice address
1101 PARK AVE, SAN JOSE, CA 95126-2911
(408) 915-1321
(408) 297-7450
Mailing address
1101 PARK AVE, SAN JOSE, CA 95126-2911
(408) 915-1321
(408) 297-7450
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
LCI04620615
CA
Other
Enumeration date
11/24/2020
Last updated
11/24/2020
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