Khadija Chisholm

Primary specialty

Mental Health CounselorTaxonomy code 101YM0800X

Practice address

3075 Adeline St Ste 120
Berkeley, CA 94703-2579

Phone

(510) 848-1112

NPI assigned

Jul 18, 2022

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Through the Looking Glass

  • Community/Behavioral Health Agency
  • Berkeley, CA
  • NPI 1528267028
  NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1658102400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1658102400000",
    "number": "1518692136",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3075 ADELINE ST STE 120",
            "city": "BERKELEY",
            "state": "CA",
            "postal_code": "947032579"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3075 ADELINE ST STE 120",
            "city": "BERKELEY",
            "state": "CA",
            "postal_code": "947032579",
            "telephone_number": "510-848-1112"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CHISHOLM",
        "first_name": "KHADIJA",
        "name_prefix": "Miss",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2022-07-18",
        "last_updated": "2022-07-18",
        "certification_date": "2022-07-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Tammy Angela Chin, M.D.
• Alix Ayame Ching, M.S., CCC-SLP
• Veronica Sue Chinsoon, CADC-II
• Ezrimayr Chioma, M.A. LMFT
• Richard Jason Chiovarelli, PSY.D.
• Grace Cho, PHARM.D.
• Jennifer H Cho, D.D.S.
• Cherri Suann Choate, DPM
• Helen O Chodsky, PA-C
• Miran Choi, M.D.

• Mental Health Counselor in Berkeley, CA
• Providers in Berkeley, CA by specialty
• Mental Health Counselor in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 18, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.