Provider Demographics
NPI:1649831439
Name:PENICK, CHARDAY (LLBSW)
Entity type:Individual
Prefix:
First Name:CHARDAY
Middle Name:
Last Name:PENICK
Suffix:
Gender:F
Credentials:LLBSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18419 FREELAND ST
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48235-2539
Mailing Address - Country:US
Mailing Address - Phone:313-656-1103
Mailing Address - Fax:
Practice Address - Street 1:TEAM WELLNESS
Practice Address - Street 2:2925 RUSSELL ST
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48207
Practice Address - Country:US
Practice Address - Phone:313-396-5300
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-06-24
Last Update Date:2019-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker