Provider Demographics
NPI:1427580612
Name:NOFLIN, INFANTA CHANTEL (EDS, LPC, NCC, RPT)
Entity Type:Individual
Prefix:
First Name:INFANTA
Middle Name:CHANTEL
Last Name:NOFLIN
Suffix:
Gender:F
Credentials:EDS, LPC, NCC, RPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:370 COURTHOUSE RD STE 102
Mailing Address - Street 2:
Mailing Address - City:GULFPORT
Mailing Address - State:MS
Mailing Address - Zip Code:39507-1889
Mailing Address - Country:US
Mailing Address - Phone:228-224-2258
Mailing Address - Fax:228-896-1155
Practice Address - Street 1:370 COURTHOUSE RD STE 102
Practice Address - Street 2:
Practice Address - City:GULFPORT
Practice Address - State:MS
Practice Address - Zip Code:39507-1889
Practice Address - Country:US
Practice Address - Phone:228-224-2258
Practice Address - Fax:228-896-1155
Is Sole Proprietor?:Yes
Enumeration Date:2017-03-28
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS2104101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS1225560410Medicaid
MS1427580612Medicaid