Provider Demographics
NPI:1548069750
Name:NDIFOR, CHANTALE NGEBUM
Entity type:Individual
Prefix:
First Name:CHANTALE
Middle Name:NGEBUM
Last Name:NDIFOR
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5442 THACKERAY DR
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28306-8464
Mailing Address - Country:US
Mailing Address - Phone:315-405-3479
Mailing Address - Fax:
Practice Address - Street 1:3530 BOONE TRL
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28306-2189
Practice Address - Country:US
Practice Address - Phone:910-758-1664
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-03-10
Last Update Date:2025-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCP0217651041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical