Basic Information
| Provider Information | |||||||||
| NPI: | 1770005381 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | CHAMBERLAIN | ||||||||
| FirstName: | ELKA | ||||||||
| MiddleName: | MARIE | ||||||||
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| Credential: | CPSS, LLMSW | ||||||||
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| Mailing Information | |||||||||
| Address1: | 491 ONYX CIR | ||||||||
| Address2: | |||||||||
| City: | WHITMORE LAKE | ||||||||
| State: | MI | ||||||||
| PostalCode: | 481898278 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8108446068 | ||||||||
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| Practice Location | |||||||||
| Address1: | 175 N GROESBECK HWY | ||||||||
| Address2: | |||||||||
| City: | MOUNT CLEMENS | ||||||||
| State: | MI | ||||||||
| PostalCode: | 480431562 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5867543060 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 07/14/2017 | ||||||||
| LastUpdateDate: | 07/14/2017 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 175T00000X | MI | N | 104100000X | 6801101538 | MI | Y | Behavioral Health & Social Service Providers | Social Worker |
No ID Information.