Individual
CHALISA SHARISE-RENEE PHIPPS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
79 W. ALEXANDRINE, DETROIT, MI 48201
(313) 831-5535
(313) 831-2608
Mailing address
79 W. ALEXANDRINE, DETROIT, MI 48201
(313) 831-5535
(313) 831-2608
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
Primary
P120115765767
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
6801094959
MICHIGAN DEPT OF LICENSING AND REGULATORY AFFAIRS
MI
Enumeration date
01/04/2011
Last updated
03/06/2015
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