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General NPI Number Information
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NPI Number | 1154672517
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Entity Type | Individual
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Provider Name | TIFFANY J CHAVIS MSW, LCSWA
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Gender | Female
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Dates
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Enumeration Date | 09/26/2012
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Last Update Date | 01/14/2013
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Provider Practice Location Address
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Address Line | 508 FULTON ST DURHAM VA MEDICAL CENTER
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City | DURHAM
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State | NC
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Zip | 27705-3875
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Country | US
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Telephone | 919-286-0411
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Fax | 919-416-5834
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Provider Business Mailing Address
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Address Line | 508 FULTON STREET DURHAM VA MEDICAL CENTER
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City | DURHAM
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State | NC
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Zip | 27705
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Country | US
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Telephone | 919-286-0411
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 104100000X
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Taxonomy Name | Social Worker
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License Number | P007644
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License Number State | NC
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