Provider Demographics
NPI:1700329448
Name:PETTIFORD, CHENELLE (CAADC)
Entity Type:Individual
Prefix:
First Name:CHENELLE
Middle Name:
Last Name:PETTIFORD
Suffix:
Gender:F
Credentials:CAADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:228 HARLEQUIN DR
Mailing Address - Street 2:
Mailing Address - City:NEW CASTLE
Mailing Address - State:DE
Mailing Address - Zip Code:19720-8900
Mailing Address - Country:US
Mailing Address - Phone:302-353-0538
Mailing Address - Fax:
Practice Address - Street 1:228 HARLEQUIN DR
Practice Address - Street 2:
Practice Address - City:NEW CASTLE
Practice Address - State:DE
Practice Address - Zip Code:19720-8900
Practice Address - Country:US
Practice Address - Phone:302-353-0538
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-11-29
Last Update Date:2017-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)