Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1041C0700X | Clinical Social Worker | 6801101207 | MI |
NPI | 1003161076 |
---|---|
Provider Name | Victoria Denise Cheatham |
First Address | Dearborn Heights, MI 48127-2126 |
Second Address | Southgate, MI 48195-3197 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 17/07/2012 |
Last Update Date | 22/03/2018 |