MEDICARE: KREISA MARQUITA CHATMAN

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	101YM0800X	Mental Health Counselor	6451019797	MI

General Provider Information

NPI Number	:	1932818994
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KREISA MARQUITA CHATMAN

Provider Business Mailing Address
First Line	:	18501 GRIGGS ST
Second Line	:
City	:	DETROIT
State	:	MI
Zip	:	48221-1935
Country	:	US
Telephone Number	:	313-742-7666
Fax Number	:

Provider Business Practice Location Address
First Line	:	18501 GRIGGS ST
Second Line	:
City	:	DETROIT
State	:	MI
Zip	:	48221-1935
Country	:	US
Telephone Number	:	313-742-7666
Fax Number	:

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

Provider Enumeration Date	:	11/18/2022
Last Update Date	:	03/11/2026

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