Provider Demographics
NPI:1700394103
Name:CHADWICK, TIFFINEY EVANGELINE
Entity Type:Individual
Prefix:
First Name:TIFFINEY
Middle Name:EVANGELINE
Last Name:CHADWICK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2015 WEBB ST
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48206-1283
Mailing Address - Country:US
Mailing Address - Phone:313-883-5614
Mailing Address - Fax:313-883-3233
Practice Address - Street 1:2015 WEBB ST
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48206-1283
Practice Address - Country:US
Practice Address - Phone:313-883-5614
Practice Address - Fax:313-218-5726
Is Sole Proprietor?:No
Enumeration Date:2018-01-19
Last Update Date:2018-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)