Provider Demographics
NPI:1851585954
Name:CHAPMAN, JACQUETTA K (BSW)
Entity Type:Individual
Prefix:MS
First Name:JACQUETTA
Middle Name:K
Last Name:CHAPMAN
Suffix:
Gender:F
Credentials:BSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20400 SUPERIOR RD
Mailing Address - Street 2:
Mailing Address - City:TAYLOR
Mailing Address - State:MI
Mailing Address - Zip Code:48180-5362
Mailing Address - Country:US
Mailing Address - Phone:734-374-2400
Mailing Address - Fax:734-374-2405
Practice Address - Street 1:20400 SUPERIOR RD
Practice Address - Street 2:
Practice Address - City:TAYLOR
Practice Address - State:MI
Practice Address - Zip Code:48180-5362
Practice Address - Country:US
Practice Address - Phone:734-374-2400
Practice Address - Fax:734-374-2405
Is Sole Proprietor?:No
Enumeration Date:2007-08-31
Last Update Date:2007-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)