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NPI Code Detail

MEDICARE: VICTORIA DENISE CHEATHAM LLMSW

MEDICARE: VICTORIA DENISE CHEATHAM LLMSW
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1171W00000XContractorMI
2172V00000XCommunity Health Worker6802087049MI
31041C0700XClinical Social Worker6801101207MI

General Provider Information

NPI Number : 1003161076
Entity Type Code : Individual
Provider Name (Legal Business Name) : VICTORIA DENISE CHEATHAM LLMSW
Provider Business Mailing Address
First Line : 6545 HIGHVIEW ST
Second Line :
City : DEARBORN HEIGHTS
State : MI
Zip : 48127-2126
Country : US
Telephone Number : 313-645-2462
Fax Number :
Provider Business Practice Location Address
First Line : 13305 REECK CT
Second Line :
City : SOUTHGATE
State : MI
Zip : 48195-3197
Country : US
Telephone Number : 734-225-2090
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/17/2012
Last Update Date : 03/22/2018

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Directions to “ VICTORIA DENISE CHEATHAM LLMSW” Practice Location

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