MEDICARE: INFANTA CHANTEL NOFLIN EDS, LPC, NCC, RPT

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
1	101YP2500X	Professional Counselor	2104	MS

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1427580612
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	INFANTA CHANTEL NOFLIN EDS, LPC, NCC, RPT

Provider Business Mailing Address
First Line	:	370 COURTHOUSE RD STE 102
Second Line	:
City	:	GULFPORT
State	:	MS
Zip	:	39507-1889
Country	:	US
Telephone Number	:	228-224-2258
Fax Number	:	228-896-1155

Provider Business Practice Location Address
First Line	:	370 COURTHOUSE RD STE 102
Second Line	:
City	:	GULFPORT
State	:	MS
Zip	:	39507-1889
Country	:	US
Telephone Number	:	228-224-2258
Fax Number	:	228-896-1155

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/28/2017
Last Update Date	:	07/21/2022

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