Provider Demographics
NPI:1902043094
Name:CHAFFIN, RHONDA IFETAYO (MSW)
Entity Type:Individual
Prefix:
First Name:RHONDA
Middle Name:IFETAYO
Last Name:CHAFFIN
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14570 GRANDVILLE AVE
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48223-2231
Mailing Address - Country:US
Mailing Address - Phone:313-303-3212
Mailing Address - Fax:
Practice Address - Street 1:14570 GRANDVILLE AVE
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48223-2231
Practice Address - Country:US
Practice Address - Phone:313-303-3212
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-01-12
Last Update Date:2009-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIL13387431041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical