Basic Information
| Provider Information | |||||||||
| NPI: | 1750771283 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | CHAMBERLIN | ||||||||
| FirstName: | ANDREW | ||||||||
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| Credential: | LPC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2489 OSEOLA AVE | ||||||||
| Address2: | |||||||||
| City: | HOWELL | ||||||||
| State: | MI | ||||||||
| PostalCode: | 488436417 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8104964935 | ||||||||
| FaxNumber: | 8105151962 | ||||||||
| Practice Location | |||||||||
| Address1: | 1063 PROFESSIONAL DR | ||||||||
| Address2: | |||||||||
| City: | FLINT | ||||||||
| State: | MI | ||||||||
| PostalCode: | 485323636 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8104964935 | ||||||||
| FaxNumber: | 8105151962 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/05/2015 | ||||||||
| LastUpdateDate: | 02/05/2015 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YP2500X | 6401012243 | MI | Y | Behavioral Health & Social Service Providers | Counselor | Professional |
No ID Information.