Provider Demographics
NPI:1255029393
Name:CHATMAN, DEXTAVIUS D (LMSW)
Entity type:Individual
Prefix:
First Name:DEXTAVIUS
Middle Name:D
Last Name:CHATMAN
Suffix:
Gender:M
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10737 S KEATING AVE
Mailing Address - Street 2:
Mailing Address - City:OAK LAWN
Mailing Address - State:IL
Mailing Address - Zip Code:60453-5482
Mailing Address - Country:US
Mailing Address - Phone:773-412-4927
Mailing Address - Fax:
Practice Address - Street 1:10737 S KEATING AVE
Practice Address - Street 2:
Practice Address - City:OAK LAWN
Practice Address - State:IL
Practice Address - Zip Code:60453-5482
Practice Address - Country:US
Practice Address - Phone:773-412-4927
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-04-26
Last Update Date:2023-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101Y00000X
IL150.110078104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No101Y00000XBehavioral Health & Social Service ProvidersCounselor