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General NPI Number Information
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NPI Number | 1861918260
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Entity Type | Organization
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Legal Business Name | JOHN CHAFFIN, ED.D., P.A.
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Dates
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Enumeration Date | 08/17/2017
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Last Update Date | 08/27/2017
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Provider Practice Location Address
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Address Line | 2312 WILTON DR STE 24
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City | WILTON MANORS
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State | FL
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Zip | 33305-1249
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Country | US
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Telephone | 954-380-8823
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Fax |
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Provider Business Mailing Address
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Address Line | 2312 WILTON DRIVE SUITE 24
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City | WILTON MANORS
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State | FL
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Zip | 33305
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Country | US
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Telephone | 954-380-8823
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Fax |
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Authorized Official
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Title or Position | LICENSED PSYCHOTHERAPIST
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Name | DR. JOHN CHAFFIN
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Credential | ED.D.
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Telephone | 954-380-8823
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | MH13783
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License Number State | FL
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